BACKGROUND Few studies have evaluated the recurrence of EGC after curative gastrectomy, due to its relatively low incidence. This study evaluated recurrence patterns and independent predictive factors for recurrence in order to determine appropriate follow-up and early detection of recurrence. METHODS We reviewed the medical records of 3,883 consecutive patients who underwent curative gastrectomy for EGC at Samsung Medical Center between February 1995 and January 2006 and were followed up until January 2008. The clinical and pathological characteristics and the predictive factors for recurrence were evaluated retrospectively. RESULTS Eighty-five (2.2%) patients had recurrence, and liver was the most common site of recurrence (45.9%). The recurrence rates within 2, 3, and 5 years were 43.5%, 67.1%, and 85.6%, respectively. There were 106 overall recurrences, with 86 (81.1%) being detected by computed tomography (CT). Second primary cancer was the primary cause of death after gastrectomy, followed by recurrence. Old age (>60 years), tumor size (>3 cm), multiple tumor, N category, and N2 station metastasis were significant factors for recurrence by multivariate analysis, but depth of invasion was not a significant factor. CONCLUSIONS Age, tumor size, number of tumors, N category, and N2 station metastasis were predictive factors for recurrence, with lymph node metastasis being the most significant factor. After curative gastrectomy, follow-up programs should be applied for more than 5 years for EGC patients, and computed tomography could be an essential diagnostic tool.