PURPOSE: Nasogastric (NG) decompression has traditionally been used following gastrectomy with extended lymph node dissection in patients with gastric cancer. A prospective randomized study of 133 patients undergoing gastric cancer surgery was performed in order to determine the necessity of routine NG decompression. METHODS: Between July 1999 and July 2000, 133 patients with gastric cancer were randomly assigned to one of two groups: NG group (n=69)-NG decompression was maintained postoperatively until a resumption of bowel function; No-NG group (n=64)-NG tube was not inserted at all, either pre- or postoperatively. RESULTS: The times to return of bowel sounds, passage of flatus and start of oral intake were all significantly (P<0.001) shortened in the No-NG group. The length of operating time and postoperative hospital stay were also decreased in the No-NG group (P<0.001). Two patients in each group (2.9% in NG and 3.1% in No-NG group) required subsequent NG decompression. There were no significant differences between the two groups concerning the presence of postoperative fever, nausea, vomiting, anastomotic leakage, pulmonary or wound complications between the two groups. There was no postoperative mortality in either group. CONCLUSION: We concluded that routine NG decompression is not necessary in elective gastric cancer surgery, even in the presence of gastric outlet obstruction.