The clinicopathologic features of patients with 47 synchronous multifocal early gastric cancers were reviewed retrospectively from hospital records between 1969 and 1994. These patients were then compared to 587 patients with solitary early gastric cancers. Accessory lesions were missed preoperatively in 15 of the 47 patients with multifocal early gastric cancers. Multifocal early gastric cancer was significantly more common in slightly older patients (multifocal versus single: 65.19 +/- 10.65 years versus 59.22 +/- 11.7 years (p = 0.004). Elevated lesions and the intestinal type of cancer were found more frequently in multifocal early gastric cancers than in solitary cancers (p < 0.005). The tumor location was higher in multiple early gastric cancers than in solitary cancers (p < 0.05). The postoperative survival did not differ between the two groups. We conclude that when planning the surgical treatment of early gastric cancers in the elderly, the whole stomach should be evaluated before and during the operation, and after the resected stomach examined.