Long-Term Survival and Follow-Up After Gastrectomy for Cancer

According to the Charter Scaligero—a consensus paper produced in 2013 in Verona during the 10th International Gastric Cancer Congress—clinical and imaging follow-up is usually provided to patients treated with radical intent, even in the absence of good quality evidence of a survival improvement. Thanks to regular follow-up, however, data on survival are available. Early gastric cancers (EGC) suitable for endoscopic treatment have a good prognosis with survival rates close to 100%. Patients with EGC who have risk factors for lymph node metastases after endoscopic resections or not meeting the criteria for endoscopic treatment must undergo surgery. In these cases, adequate lymphadenectomy offers a high probability of cure with successful survival (>90% 5-year disease-free survival). Submucosal invasion, Lauren diffuse/mixed type, Kodama Pen A type and tumor size are associated with an increased risk of lymph node metastases even in EGC. Advanced gastric cancers should undergo gastrectomy and standard D2 lymphadenectomy, if necessary combined with perioperative chemotherapy. Five-year overall survival for stage II and III range from 44% to 86% and from 22% to 64%, respectively. Finally, the survival of stage IV patients remains poor. Chemotherapy is the treatment of choice and the role of surgery is limited to palliation of symptoms and to selected cases of oligometastatic disease.