The purpose of this article is to review the incidence and characteristic of first recurrence in a group of 182 patients who underwent curative surgery with extended lymphadenectomy (> or = D2). The median follow up was 46.4 months (range 14-111). The incidence of relapses was 3.3% in the early gastric cancer and 50.8% in the advanced cancer. First recurrence site was systemic in 69.4% of cases and locoregional in 22.6%. The major site of systemic recurrences were peritoneal surface (64.8%), liver (29.5%), and other extra abdominal metastases (5.7%). In 8% of the cases it was not possible to find the site of recurrence. Surgical resection was possible in only 2 out of 14 cases of local recurrence. The incidence of recurrence were directly correlated with the depth of tumor invasion (T1: 3.3%; T2: 20.6%; T3: 61.5%; T4: 70%) and node metastases (NO: 8.3%; N1+: 44.4%; N2+: 64.3%). In advanced cases the incidence of relapses after D1 lymphadenectomy was significantly higher than after D2 lymphadenectomy: 28.6% vs 5.5% in NO cases and 65.6% vs 49.3% in N+ cases. In conclusion it seems that extended lymphadenectomy is associated with a lower incidence of recurrences after curative surgery.
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