32 Jun SY and Park JK Materials and Methods Among the 41 patients who were pathologically diagnosed with Krukenberg tumor after the second surgery at the Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan Univer- sity School of Medicine during 27 years from 1981 to 2008, this study was conducted on 22 patients who were considered to have Krukenberg tumor that metastasized from gastric cancer, based on the history of surgery for gastric cancer. First, the incidence of Krukenberg tumor that originated from gastric cancer after gas- trectomy was examined by assessing the number of female patients who underwent surgery for gastric cancer during the same period. In addition, the age of onset of the 22 Krukenberg tumor patients, the menopause status, the tumor markers, the tumor node metas- tasis (TNM) disease stage according to the American Joint Com- mittee on Cancer (AJCC) 6th edition(5) and the presence of factors that could mediate effects on the survival rate were examined by retrospectively assessing the histopathological grade of cell dif- ferentiation, the interval from the first surgery to the development of tumor, the surgical methods for Krukenberg tumor, whether or not more than 4 cycles of adjuvant chemotherapy was performed and the survival rate after the second surgery, based on the medical records. The follow-up observation of the patients was performed using the database at the outpatient department or by telephone follow-ups, and the mean follow-up period was 25.２ months. The survival rate of the Krukenberg tumor patients was analyzed by the Kaplan-Meier method and the Log-Rank test, and P-values＜0.05 were determined to be significant. All the statistical analyses were performed using the SPSS for Windows 12.0. Results The Krukenberg tumor patients were confirmed by the second surgery after the primary surgery for gastric cancer, and 22 patients were thought to have ovarian tumor that metastasized from gastric cancer. In regard to the primary cancer of the 41 Krukenberg tu- mor patients diagnosed after the second surgery during the same period, 53.7% of them had gastric cancer. In addition, there were 693 female patients who received gastrectomy after the diagnosis of gastric cancer during the same period and so the incidence of Krukenberg tumor that developed during the follow-up period af- ter gastrectomy was 3.2%. As for the major symptoms of Krukenberg tumor, lower ab- dominal discomfort and intermittent abdominal pain were noted in 10 cases (45.5%), no symptoms other than the detection of an ovarian mass by abdominal ultrasonography during regular physi- cal check-ups was noted in ６cases (27.3%), palpation of a mass in the lower abdomen was noted in 4 cases (18.2%) and abdominal distention associated with ascites, abscess within the pelvis and fever was noted in one case each (4.5%). As for the diagnostic method, except for 1 patient with an intrapelvic abscess, 21 cases (95.5%) were diagnosed with an ovarian mass that was suspicious to be malignant by the abdominal sonography and abdominal CT performed prior to the second surgery. These patients and their masses were subsequently definitely diagnosed by examining the frozen sections during surgery. The interval from the first surgery to the resurgery for Kruken- berg tumor was on average 16.5 months (range: 3~34 months). The mean age of the patients was 48.6 years (range: 24~78 years), 13 patients were premenopausal women (59.1%) and there were 9 postmenopausal women (40.9%). During the first surgery, concern- ing the disease stage of the primary tumor according to the AJCC TNM disease stage classification, 6th edition, there was 1 case of stage 0 (4.5%), there were 2 cases of stage IA (9.1%), there were 4 cases of stage IB (18.2%), there were 6 cases of stage II (27.3%), there were 4 cases of stage IIIA (18.2%) and 1 case of stage IV (4.5%). The disease stage II was the most prevalent. In addition, with regard to the depth of lesions, there was 1 case of Tis (4.5%), there were 7 cases of T1 (31.8%), there were 6 case of T2a/2b (27.3%), there were 7 cases of T3 (73.8%) and 1 case of T4 (4.5%). Regarding lymphovascular involvement, there were 5 cases of N0 (22.7%), 9 cases of N1 (40.9%) and 1 case of (4.5%). Regarding the histologic grade, 10 patients had moderately differentiated tumor (45.5%) and 8 patients had well differentiated tumor (36.4%). As for the clinical characteristics of Krukenberg tumor, the av- erage long axis was 12.9 cm (range: 4.6~18.０cm), 18 patients had bilateral tumors (81.8%) and 4 patients had unilateral tumor (18.2%). As the recurrence patterns, 11 patients had tumor limited to the ovary (50.0%), 5 patients recurred within the pelvic cavity (22.7%) and 6 patients’ tumor had metastasized to organs other than the abdomen and the pelvis (27.3%). Concerning surgical treatments, laparotomy was performed on all 22 patients, and bilateral oo- phorectomy was performed on all 22 patients. Hysterectomy was performed simultaneously on 10 patients, including 5 patients for whom invasion to the uterus was suspected. There were 14 patients without macroscopic residual tumors after tumor resection (63.6%). Including the 3 patients (13.6%) whose tumor had metastasized to the great omentum at the time of the second surgery, 8 (36.4%)