PURPOSE: Angiogenesis is essential for tumor growth and metastasis and depends on the production of angiogenic factors that are secreted by tumor cells. Vascular endothelial growth factor (VEGF) is the most significant angiogenic factor and a selective mitogen for endothelial cells. VEGF, also known as the vascular permeability factor, acts on endothelial cells to increase microvascular permeability and directly stimulate the growth of new blood vessels. Several studies have reported that the expression of VEGF is correlated with hematogenous recurrence via angiogenesis in gastric carcinomas. This research evaluated the relationship between the expression of VEGF and hepatic and peritoneal recurrence in gastric carcinomas. MATENRIALS AND METHODS: Thirty specimens resected from patients with primary gastric carcinomas who had undergone curative resections were divided into three group: Group I, early gastric carcinomas without recurrence; Group II, advanced gastric carcinomas with hepatic recurrence; and Group III, advanced gastric carcinomas with peritoneal recurrence. The expression of VEGF and the density of the microvessel count were examined using immunohistochemistry. RESULTS: 1) The expression of VEGF in Group II and Group III (63.2+/-24.3%) was stronger than that in Group I(7+/-4.2%). The expression of VEGF in Group II (76.5+/-13.2%) was stronger than that of the Group III (50+/-14.2%) (P<0.05). 2) The microvessel count in Group II (49.9+/-14.5) was more than that in Group I (8.6+/-2.6) and Group III (29.1+/-18.1) (P<0.05). 3) The microvessel count was increased significantly with increasing the expression of VEGF. CONCLUSION: The expression of VEGF is associated with advanced stomach cancer and hepatic recurrence has a higher expression of VEGF than peritoneal recurrence with neovascularization. Thus the expression of VEGF can be considered to be a useful indicator of recurrence in gastric carcinoma and especially in hepatic recurrence.