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To review recurrence patterns in completely resected gastric adenocarcinoma.Despite improvements in the surgical treatment of gastric adenocarcinoma, recurrence rates remain high in patients with advanced stage disease. Understanding the timing and patterns of recurrence is essential to develop effective adjuvant treatment strategies.A retrospective review of a prospectively maintained gastric cancer database was carried out. The timing and pattern of recurrence were reviewed. Univariate and multivariate analyses were performed to identify factors predictive of recurrence patterns.From July 1985 through June 2000, 1172 patients underwent an R0 resection. Of these, 496 (42%) had recurrence and complete data on recurrence could be obtained in 367 patients (74%). Among the documented recurrences, 79% were detected within 2 years of operation. Locoregional sites were involved as any part of the recurrence pattern in 199 patients (54%). Distant sites were involved as any part of the recurrence in 188 patients (51%) and peritoneal recurrence was detected as any part of the recurrence in 108 patients (29%). On multivariate analysis, peritoneal recurrence was associated with female gender, advanced T-stage, and distal and diffuse type tumors; locoregional recurrence was associated with male gender and proximal location; distant recurrence was associated with proximal location, early T stage, and intestinal type tumors. The median time to death from the time of recurrence was 6 months.Recurrence after complete resection of gastric adenocarcinoma usually occurs within 2 years and is rapidly fatal. Patterns of recurrence are variable and may be associated with specific clinicopathologic factors.