Is gastric cancer generalized at the time of surgery?

Twenty-one patients undergoing gastrectomy for adenocarcinoma of the stomach died during the first two postoperative weeks and were subjected to autopsy. They all had "curative" resections for lesions confined to the stomach and the regional lymph nodes. Autopsy revealed distant metastasis in ten of 13 patients who had (TNM) stage III disease at the time of surgery. There was no residual disease in patients with stage I and II lesions (P less than 0.01). The study suggests that, in most cases, stage III gastric adenocarcinomas have already spread beyond the confines of gastrectomy at the time of operation.