E-Mail karger@karger.com Dig Surg 2013;30:159–168 DOI: 10.1159/000350878 Follow-Up: The Evidence Domenico D’Ugo Alberto Biondi Andrea Tufo Roberto Persiani Department of Surgery, ‘A. Gemelli’ Hospital, Università Cattolica del Sacro Cuore, Rome, Italy Introduction The potential value of a surveillance program in pa- tients who have undergone cancer surgery is to detect re- currences in the early and asymptomatic period, to iden- tify complications associated with surgery, and to collect outcome data. Early detection of cancer recurrence may be associated with improved survival because it may pro- vide an opportunity for treatment to be initiated while the patient’s condition is sufficiently stable to receive effec- tive therapy. A postoperative follow-up schedule is recommended for nearly all cancers in international guidelines even though the value of postoperative surveillance remains controversial [1, 2]. In colorectal and breast cancers, sev- eral randomized controlled trials and meta-analyses have demonstrated an overall survival advantage associated with detection of recurrences through intensive follow- up as compared with patients who present later with symptomatic recurrences [3, 4]. Gastric cancer is one of the most frequent malignan- cies and the second leading cause of cancer deaths world- wide, with 989,600 new cases and 738,000 deaths in 2008, accounting for 8% of the total cases and 10% of total deaths for cancer [5]. Key Words Gastric cancer · Postoperative follow-up · Surveillance Abstract There is currently no consensus on the best strategy for the follow-up of patients who have undergone surgical treat- ment with curative intent for gastric cancer. The wide varia- tion in recommendations for surveillance among interna- tional experts and hospital schedules clearly reflects a lack of an established body of evidence on this subject. Conse- quently, most of the international guidelines aimed at early detection of disease recurrence gloss over details concern- ing the mode, duration, and intensity of surveillance since they cannot be based on an acceptable grade of recommen- dation. Very few report anything other than the detection of recurrences or death as the primary endpoints, and, given the poor survival of patients with recurrent gastric cancer, the prognostic effect of early detection seems doubtful. In recent years, an increasing focus on evidence-based medi- cine, which has coincided with a growing concern about costs and efficiency in medicine, has caused a reevaluation of most surveillance practices. In this paper, we review and discuss the current body of evidence and follow-up practices after curative resection of gastric cancer. Copyright © 2013 S. Karger AG, Basel Published online: ■■■ Domenico D’Ugo Department of Surgery, ‘A. Gemelli’ Hospital Università Cattolica del Sacro Cuore Largo A. Gemelli 8, IT–00167 Rome (Italy) E-Mail ddugo  @  rm.unicatt.it © 2013 S. Karger AG, Basel 0253–4886/13/0302–0159$38.00/0 www.karger.com/dsu DSU350878.indd 159 DSU350878.indd 159 22.05.2013 15:47:16 22.05.2013 15:47:16