[The fifth metastasis route of gastric cancer and the third principle of radical operation].

The local-regional recurrence is the most important failure reason of D2 radical operation for curative advanced gastric cancer. Another way of metastasis, which exists in the mesogastrium and separates apart from the primary tumor, blood vessels and lymph nodes, appears to be responsible for the local-regional recurrence partly. We call it as the fifth route of metastasis. The mesogastrium is surrounded by proper fascia completely and covered partly by serosa. We suggest that D2 radical operation should not only include the resection of primary tumor and lymphadenectomy, but also add the complete mesogastric excision (CME) as the third principle in gastric cancer radical operations to cut down the fifth metastasis route of gastric cancer, to prevent the fifth metastasis scattered on the field of operation which may induce the local-regional recurrence.