Purpose: The prognosis of stage IV gastric cancer is poor with the 5-year survival rate still being about 10%. We investigated the prognostic factors of stage IV gastric cancer patients who underwent resection. Materials and Methods: A retrospective study of 383 patients with stage IV gastric cancer who underwent surgery in our department between September 1983 to December 2000 was conducted. We classified the 383 patients into two groups: patients surviving 2 years or more (n=77) and those surviving less than 2 years (n=306). Clinicopathologic differences were analyzed between the two groups. We also performed univariate and multivariate analyses of various clinicopathologic factors concerning survival. Results: Statistically significant clinicopathologic differences between the two groups were observed in regard to macroscopic type, distant metastasis, lymph node dissection, curability, and histology. Curability and histology were significant survival factors in 2-year survival. The 5-year survival rate was 5.4% in stage IV gastric cancer. Significant differences in survival among macroscopic type, distant metastasis, lymph node dissection, curability and histology were observed in the univariate analysis. In the Multivariate analysis, Curability, lymph node dissection, and histology were significantly beneficial factors for survival. Conclusion: Lymph node dissection, curability, and histology were independent prognostic factors in stage IV gastric cancer, and radical treatment is recommended to improve survival.