Among 452 patients who underwent operation for early gastric cancer, 101 were late deaths. The cause of death in these patients was studied with special reference to cancer recurrence and the occurrence of metachronous cancers in other organs. Of these 101 patients, 63 died of noncancerous diseases, the other 38 of cancer. Among the latter, 15 patients died of recurrence more than 5 years after operation; macroscopically, the protruded or elevated type combined with the depressed or excavated type were found more frequently in the primary lesions. Differentiated adenocarcinoma was a characteristic histologic findings for these lesions, and hematogenic metastasis was the most frequent recurrence pattern. Ten patients with early gastric cancer who underwent operation died of metachronous cancer in other organs. Our findings suggest that in the long-term follow-up of patients with early gastric cancer who undergo operation, the occurrence of metachronous cancer in other organs should be considered in addition to recurrence of cancer.