35 Krukenberg Tumor from Gastric Cancer Treated patients (81.8%) with bilateral tumor. Thus, additional tests must be performed on the bilateral ovarian tumors detected in premeno- pausal women after they have undergone surgery for gastric cancer. Koyama et al.(18）have reported that even if ascites, abdominal pain or other symptoms are not detected by physical examina- tion, for patients with the past history of surgery for gastric cancer or other digestive tract cancer, the presence or absence of ascites should be assessed by abdominal ultrasonography or CT, and ef- forts should be made to diagnose ovarian cancer early. In addition, Krukenberg tumor should be always be suspected if on CT the tumor is bilateral and it is characterized by lobulated solid tumors, and enhancement with contrast medium is noticeable in the ovary. So, only an early diagnosis that allows the complete resection of tumor can improve the survival rate of Krukenberg tumor, and McGill et al.(19）stated that gynecologists should comprehensively examine the upper abdominal area during surgery, and surgeons should comprehensively examine the lower abdominal area during surgery. This should be encouraged now that endoscopic submu- cosal dissection, laparoscopic gastrectomy and robotic surgery are becoming more common. Concerning the prognosis of Krukenberg tumor, the radical re- section of Krukenberg tumor without leaving macroscopic residual lesions is difficult in many cases, and it has been reported that the median duration of survival ranges from 7.7 to 14.0 months.(1,3,13) In our study, the average survival rate was 18.8 months and this in- cludes 2 patients who are still alive 22 and 59 months after surgery, the overall 3-year survival rate was approximately 15.7% and the prognosis was not good, but it was better than that of other reports. The reasons that the survival rate in our study were slightly high may be diverse, yet it may be due to the proportion of patients in- cidentally detected during physical examination. So an early diag- nosis was possible for ６ patients, and the patients for whom com- plete resection of Krukenberg tumor was difficult were transferred to other hospitals and so there were relatively fewer patients with the incomplete resection of tumors. Yada-Hashimoto et al.(2) have reported that even for patients with metastatic ovarian cancer origi- nated from tumors in non-intrapelvic organs, including Krukenberg tumor, a postsurgical 5-year survival rate higher than 19% could be anticipated. They also mentioned that if the metastatic ovarian can- cer is completely resected, then better results than anticipated could be obtained, so they emphasized aggressive resection. Of course, for all metachronous Krukenberg tumors, the feasibility of resec- tion may be determined according to the extraovarian metastasis at the time of ovarian metasectomy. The survival rate for our patients who underwent aggressive tumor resection without residual cancer was on average 23.7 months, and this was significantly higher than the 6.0 months for the average survival period of the patients who underwent palliative resection because of tumor invasion to other organs and the adjacent pelvis. This suggests that only an early diagnosis and efforts to remove tumor-burdened intrapelvic organs could increase the survival period. In regard to the factors exerting effects on the postsurgical survival rate, most studies have reported that the age of patients at the time of the diagnosis of Krukenberg tumor, the menopause status, the primary tumor site, the grade of differentiation of the tumor cells and the disease stage were not associated with the postsurgical survival rate, and similar to other malignant tumors, only aggressive resection could increase the survival rate.(1,3,15) It has recently been reported that postsurgical adjuvant chemoradiation therapy had a major impact on the local recurrence in patients with resectable gastric cancer.(20) However, the effect of adjuvant chemoradiation therapy after the resection of Krukenberg tumor is still controversial. Numerous studies have reported that it did not mediate effects on the survival rate.(1,21) In our study, similarly, the survival rate of the 15 patients who under- went more than 4 cycles of the therapy was not different from the 15 patients who did not receive adjuvant therapies, and the survival rate was also not associated with the types of chemotherapeutic agents. When performing colectomy for colorectal cancer, for women older than 40 years, attempts to perform prophylactic bilateral ovariectomy have been made in some cases,(22) but this is still controversial for the patients who have undergone gastrectomy． Yamamoto et al.(23) stated that prophylactic ovariectomy could be considered if it is not possible to resect the tumor from the ovary without macroscopic abnormalities and if the CEA value is high after washing the peritoneal cavity with approximately 100 ml sa- line. The feasibility of the early detection of Krukenberg tumor by tumor markers has been reported in several studies, yet most of the markers have been shown to be non-specific. It has been reported that the rapid elevation of the CA-125 level has been widely ap- plied as a marker of ovarian cancer and this is of help to make the early diagnosis of Krukenberg tumor.(2) In our study, there were only 2 patients (9.1%) with the rapid increase of the CA-125 level to higher than 100 U/ml and the percentage of patients with a higher than average value were only 45.5%, and so this marker was not of great help. As compared with the observation that the CEA and CA 19-9 levels were not changed in most patients, among 9 patients for whom the measurement of CA-125 was performed, it