Four hundred and four patients underwent surgical treatment for adenocarcinoma of the gastric cardia in our hospital between January 1980 to June 1990. Of 342 resected cases, 231 cases were treated with surgery alone, their 1-, 3-, and 5-year survival rates were 83.8%, 38.5% and 20.8%, respectively. Since January 1987, postoperative chemotherapy was given in 47 patients, their 1-, 3-, and 5-year survival rates were 89.4%, 46.8%, 29.8%, respectively, while intraoperative chemotherapy in 54 cases, had 1-, 3-, and 5-year survival rates of 87.1%, 63.0% and 38.9%, respectively. The result showed that the 3- and 5-year survival rates were higher in postoperative chemotherapy cases than in cases with operation alone, but there was no statistical significance between the two groups. However, intraoperative chemotherapy group had much higher 3- and 5-year survival rates than operation alone (P < 0.01). Intra-operative chemotherapy is recommended especially in patients beyond stage I with lymph node metastasis.