PURPOSE: Despite numorous reports on the relationship between the level of carcinoembryonic antigen (CEA) in gall bladder bile and liver metastasis in colorectal cancer, no similar studies have been carried out for gastric carcinomas. We, therefore, undertook the present study to establish the relationship between the gall bladder bile CEA and liver metastasis as well as the post-operative survival rate in gastric carcinoma patients with curative resections. MATERIALS AND METHODS: In 373 gastric cancer patients (252 males, 121 females, age 21~76 years) operated on at Kosin University Hospital between 1989~1996, the CEA concentration in the gall bladder bile was determined during the operation and the value was related to the rates of post-operative survival and liver metastasis during follow-up period. RESULTS: The overall rate of patient survival decreased gradually with increase in TNM stage. The 13-year post-operative survival rates for stages Ia, Ib, II, IIIa, and IIIb were 95.7%, 92.5%, 79.9%, 50.9%, and 43.3%, respectively, and the 10-year survival rate for stage IV was 22.6%. The patients with a high (> or =10 ng/ml) biliary CEA showed a significantly lower rate of survival than those with a low (<10 ng/ml) biliary CEA. The 13-year cumulative survival rate was 55.4% for the high CEA group and 76.5% for the low CEA group (P<0.01). Also, the patients with a high biliary CEA showed a significantly higher rate (11.5%) of liver metastasis than those with a low biliary CEA (1.9%) (P<0.000). In patients with TNM stages (I and II), the CEA level did not affect the post-operative survival rates (95.4% and 87.7% in the high and low CEA groups, P>0.10), but in those with high TNM stages (III and IV), the survival rate was significantly lower in the high CEA group (25.9%) than in the low CEA group (57.8%) (P<0.05). CONCLUSION: These result suggest that the gall bladder bile CEA level obtained in an advanced-staged gastric cancer operation may be used in predicting the post-operational survival rate and in sorting out patients with a high risk for cancer recurrence, especially in the liver area.