Follow-up and treatment of recurrence

About two-thirds of patients with advanced gastric cancer treated by R0 resection develop tumor relapse during the follow-up, and most of them will die from the disease. The main patterns of dissemination are peritoneal, hematogenous, and locoregional, and their incidence differs according to multiple clinical, surgical, and pathological factors. The main purpose of follow-up is to diagnose tumor relapse as early as possible. An ideal follow-up program is one that is individualized according to the predicted risk, timing, and site of recurrence. However, the real clinical utility of these programs is affected by the low chance of cure for recurrent gastric cancer. Surgical treatment has a limited role and is indicated only in a few cases of resectable locoregional recurrences, isolated liver metastases, or limited peritoneal carcinomatosis. Currently, the prevention of recurrence is probably more important than its early detection. A correct surgical procedure and the selection of pre-, peri- or postoperative systemic and/or locoregional treatments could improve the prognosis of gastric cancer patients. The Italian Research Group for Gastric cancer has developed an individualized follow-up program based on the risk of recurrence and patients’ compliance with follow-up. Three different schedules (mild, moderate, or intensive) are proposed.