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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