Mechanisms of late recurrence after radical surgery for gastric carcinoma.

Factors involved in late recurrence of gastric carcinoma were investigated in 25 patients with late recurrence who died five or more years after radical surgery and 129 with early recurrence who died within two years after surgery. In the patients with late recurrence, the important routes of cancer spread in the initial phase of the recurrence were contiguous invasion and lymphatic spread. Whether early or late recurrence occurred had a high correlation with the following four conditions: (1) the amount of residual cancer left at the time of surgery; (2) the spread of the residual cancer; (3) the rate of cancer proliferation; and (4) the resistance of the host. To prevent late recurrence, it is necessary not to leave any cancer tissue in these routes at the time of gastrectomy, as well as to employ adjuvant chemo- and immunotherapy for the inhibition of cancer proliferation and elevation of the host resistance.