36 Jun SY and Park JK was shown to be elevated in 8 patients. Since CA-125 was helpful to predict the development of Krukenberg tumor after surgery for cancer in the digestive tract, it may be better to test the CA-125 tumor marker during the follow-up observation period. In summary, the incidence of the metastatic ovarian cancer that developed during the follow-up observation period after gastrecto- my (Krukenberg tumor) was 3.2%. Even if surgery was performed, the mean survival period was 18.8 months, and the prognosis was poor. Nonetheless, the 3-year survival rate was 15.8%, and so attempts to resect tumors as the second tumor reduction seem worthwhile. Although several factors may mediate effects on the survival rate, the most important factor that affects the survival rate is the complete resection of tumors. Yet the recurrence patterns are important, and aggressive efforts not to leave residual cancer cells at the second surgery are required. In addition, for all female gastric cancer patients who have undergone a gastrectomy and especially young premenopausal women, a suspicion of Krukenberg tumor can help make an early diagnosis by comprehensively assessing the CA-125 level and other tumor markers, as well as by performing lower abdominal ultrasonography. References 1. Wang J, Shi YK, Wu LY, Wang JW, Yang S, Yang JL, et al. Prognostic factors for ovarian metastases from primary gas- tric cancer. Int J Gynecol Cancer 2008;18:825-832. 2. Yada-Hashimoto N, Yamamoto T, Kamiura S, Seino H, Ohira H, Sawai K, et al. Metastatic ovarian tumors: a review of 64 cases. Gynecol Oncol 2003;89:314-317. 3. Cheong JH, Hyung WJ, Chen J, Kim J, Choi SH, Noh SH. Survival benefit of metastasectomy for Krukenberg tumors from gastric cancer. Gynecol Oncol 2004;94:477-482. 4. Kiyokawa T, Young RH, Scully RE. Krukenberg tumors of the ovary: a clinicopathologic analysis of 120 cases with emphasis on their variable pathologic manifestations. Am J Surg Pathol 2006;30:277-299. 5. Sobin LH, Wittekind C, eds. TNM Classification of Malignant Tumours (UICC). 6th ed. New York: Wiley-Liss, 2002:65-68. 6. Kakushima N, Kamoshida T, Hirai S, Hotta S, Hirayama T, Yamada J, et al. Early gastric cancer with Krukenberg tumor and review of cases of intramucosal gastric cancers with Krukenberg tumor. J Gastroenterol 2003;38:1176-1180. 7. Nam SY, Choi IJ, Park KW, Kim CG, Lee JY, Kook MC, et al. Effect of repeated endoscopic screening on the incidence and treatment of gastric cancer in health screenees. Eur J Gastro- enterol Hepatol 2009;21:855-860. 8. Novak C, Gray LA. Krukenberg tumor of the ovary: clinical and pathological study of four cases. Surg Gynecol Obstet 1938;66:157-165. 9. Serov SF, Scully RE, Sobin LH. Histological Typing of Ovar- ian Tumours. International Histological Classification of Tu- mours. No 9. Geneva: WHO, 1973:17-54. 10. Lerwill MF, Young RH. Ovarian metastases of intestinal-type gastric carcinoma: a clinicopathologic study of 4 cases with contrasting features to those of the Krukenberg tumor. Am J Surg Pathol 2006;30:1382-1388. 11. Yoo CH, Noh SH, Shin DW, Choi SH, Min JS. Recurrence following curative resection for gastric carcinoma. Br J Surg 2000;87:236-242. 12. Shin DW, Hyung WJ, Noh SH, Min JS. Risk factors for recur- rence after curative surgery for early gastric cancer. J Korean Gastric Cancer Assoc 2001;1:106-112. 13. Berek JS, Natarajan S. Ovarian and fallopian tube cancer. In: Berek JS, ed. Berek and Novak’s Gynecology. 14th ed. Phila- delphia: Lippincott Williams and Wilkins, 2007:1457-1547. 14. McGill F, Ritter DB, Rickard C, Kaleya RN, Wadler S, Greston WM. Management of Krukenberg tumors: an 11-year expe- rience and review of literature. Prim Care Update Ob Gyns 1998;5:157-158. 15. Kim HK, Heo DS, Bang YJ, Kim NK. Prognostic factors of Krukenberg's tumor. Gynecol Oncol 2001;82:105-109. 16. Shen-Gunther J, Mannel RS. Ascites as a predictor of ovarian malignancy. Gynecol Oncol 2002;87:77-83. 17. Mateş IN, Iosif C, Bănceanu G, Ionescu M, Peltecu G, Dinu D, et al. Features of Krukenberg-type tumors--clinical study and review. Chirurgia (Bucur) 2008;103:23-38. 18. Koyama T, Mikami Y, Saga T, Tamai K, Togashi K. Secondary ovarian tumors: spectrum of CT and MR features with patho- logic correlation. Abdom Imaging 2007;32:784-795. 19. McGill FM, Ritter DB, Rickard CS, Kaleya RN, Wadler S, Greston WM, et al. Krukenberg tumors: can management be improved? Gynecol Obstet Invest 1999;48:61-65. 20. Dikken JL, Jansen EP, Cats A, Bakker B, Hartgrink HH, Kranenbarg EM, et al. Impact of extent of surgery and post- operative chemoradiotherapy on recurrence patterns in gas- tric cancer. J Clin Oncol 2010;28:2430-2436. 21. Wagner AD, Grothe W, Haerting J, Kleber G, Grothey A, Fleig WE. Chemotherapy in advanced gastric cancer: a sys-