ORIGINAL ARTICLE – GASTROINTESTINAL ONCOLOGY Follow-Up Strategy After Curative Resection of Gastric Cancer: A Nationwide Survey in Korea Hoon Hur, MD, Kyo Young Song, MD, PhD, Cho Hyun Park, MD, PhD, and Hae Myung Jeon, MD, PhD Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea ABSTRACT Background. To date, guidelines for follow-up after curative resection in patients with gastric cancer have not been reported. Thus, most centers have managed the pro- cess according to institution-specific protocols. We investigated current follow-up practices after curative resection of gastric cancer using a nationwide survey in Korea, where gastric cancer is epidemic. Methods. From July to September 2007, questionnaires were sent out to 205 members of the Korean Gastric Cancer Association (KGCA). The questionnaire packet contained a covering letter, general information, and a questionnaire about follow-up schedules and methodologies. Results. Forty-six percent (96/205) of the members of the KGCA returned the survey. The majority of responders indicated that patients with early gastric cancer were fol- lowed up every 6 months (64.4%) for the first year, every 12 months (47.9%) for the next 4 years, and every 12 months (68.8%) from the fifth year after surgery on. For patients with advanced gastric cancer, follow-up studies were carried out every 3 months (43.8%) for the first year, every 6 months for the next 4 years, and every 12 months (75.0%) from the fifth year onward. After surgery, most responders used computed tomography for imaging, car- cinoembryonic antigen (CEA) and carbohydrate antigen (CA)19-9 as tumor markers, and serum iron among follow- up measures. Conclusions. Clinicians have a variety of approaches regarding the extent of follow-up and methodologies used after curative resection for gastric cancer. Therefore, a multicenter randomized trial will be needed to compare routine follow-up with intensive schedules. Our results could facilitate the design of such studies. Although the incidence and mortality of gastric cancer have gradually decreased throughout the world, the con- dition is one of the most common malignancies in eastern Asia, particularly in Korea and Japan. 1 For locally confined gastric cancer, curative resection has proven to be the only successful treatment modality. 2 In eastern Asia, the number of patients diagnosed with early-stage disease is increasing; most patients with gastric cancer undergo R0 resection. Longer disease-free states in these patients following curative resection highlight the importance of follow-up studies for postoperative patients. All patients who have undergone curative resection for gastric cancer should be followed up for the following two purposes. The primary goal of this strategy is to improve survival and quality of life, which is less of a challenge when a recurrence of gastric cancer is detected early. The secondary goal is supplementing various nutrient defi- ciencies in patients who have anatomical or metabolic changes resulting from gastrectomy and reconstruction. Previous systematic reviews of follow-up care in the context of various cancers revealed that intensive follow- up for patients with colorectal cancer could increase sur- vival, while a minimal or routine approach was as effective as intensive follow-up in breast cancer after curative sur- gery. 3,4 Based on these results, the American Society of Clinical Oncology (ASCO) has suggested guidelines for the follow-up of colorectal cancer and breast cancer. 5,6 However, the principles of follow-up for gastric cancer have not yet been established since there have been no randomized controlled clinical trials to delineate a stan- dardized protocol for postoperative care. At present, most centers performing gastric resection and follow-up have unique follow-up programs dictated by past practices at the particular institution. Ó Society of Surgical Oncology 2009 First Received: 18 November 2008; Published Online: 24 September 2009 H. M. Jeon, MD, PhD e-mail: hmjeon@catholic.ac.kr Ann Surg Oncol (2010) 17:54–64 DOI 10.1245/s10434-009-0676-1