Welcome to the Surveillance After Resection of Oesophageal aNd Gastric cancer (SARONG) Trial

do we need a RCT in oeosophgael and gastric cancer surveillance?

Currently, national or international guidelines do not provide a routine surveillance for the detection of recurrent disease in patients without symptom or evidence of residual disease after treatment for oesophago-gastric cancer with curative intent (NICE guideline [1]).
There has yet to be a randomised controlled trial (RCT) that has compared survival between oesophago-gastric cancer patients undergoing different surveillance protocols.
There is considerable interest in the oesophago-gastric cancer community in pursuing this.

Reference

1. NICE guidelines for oesophago-gastric cancer assessment and management. https://www.nice.org.uk/guidance/ng83/resources/oesophagogastric-cancer-assessment-and-management-in-adults-pdf-1837693014469

What is SARONG

The SARONG study is a multi-centre, open-label, two-arm, parallel design, superiority Randomised Controlled Trial.
The study aims to determine whether intensive surveillance after completing curatively intended treatment improves survival and health-related quality of life in patients with oesophageal or gastric cancer.
The SARONG study will recruit adults (aged 16 years or over) receiving surgical resection for curatively intended treatment of oesophageal or gastric cancer with or without neoadjuvant/adjuvant chemo(radio)therapy/ immunotherapy.
Participant will be randomised to either standard of care or intense surveillance intensive surveillance (including radiological scans (chest and abdomen) and clinical review) every 6 months for 36 months post-randomisation along with an endoscopy at 12 months post-randomisation.

952 patients (476 in each of two trial arms) will be recruited over a period of 32 months from approximately 24 sites in the UK.

The ENSURE Study

European Investigation of Surveillance after Resection for Esophageal cancer (ENSURE study)

The results of this European study reinforce the need of a RCT:

The survey established that there is widespread heterogeneity in surveillance protocols in Europe, and the vast majority of centres agreed there is a need for an RCT examining this issue.
Intensive surveillance was associated with increased detection of isolated or anastomotic recurrence and improved overall survival.

Reference

Elliott JA, Markar SR, Klevebro F, et al; ENSURE Study Group. An International Multicenter Study Exploring Whether Surveillance After Esophageal Cancer Surgery Impacts Oncological and Quality of Life Outcomes (ENSURE). Ann Surg. 2022 Jan 27.

Oesophago-Gastric Cancer Community

A questionnaire study of 27 oesophago-gastric UK specialist centres showed

willingness to participate in an RCT to empirically evaluate the prognostic value of intensive surveillance after oesophageal and gastric cancer resections [1].

A survey study of 107 former oesophageal or gastric cancer patients showed that

patients felt that intensive surveillance would be reassuring for them regarding their ongoing cancer care and monitoring for recurrence [2].

Reference

1. Chidambaram S, Sounderajah V, Maynard N, Underwood T, Markar SR. Evaluation of postoperative surveillance strategies for esophago-gastric cancers in the UK and Ireland. Dis Esophagus. 2022 Feb 11;35(2):doab057

2. Elliott JA, Markar SR, Klevebro F, et al; ENSURE Study Group. An International Multicenter Study Exploring Whether Surveillance After Esophageal Cancer Surgery Impacts Oncological and Quality of Life Outcomes (ENSURE). Ann Surg. 2022 Jan 27.