Background: Metastatic gastric cancer has poor survival. The purpose of this study was to compare outcomes of metastatic gastric cancer patients stratified by surgery and radiation therapy. Methods: The SEER database was accessed to identify AJCC M1 stage IV (6^th ed) gastric cancer patients between 2004 thru 2008. Patients were divided into 4 groups; group 1: no surgery or radiation; group 2: radiation alone; group 3: surgery alone; group 4: surgery and radiation. Survival analysis was determined by Kaplan-Meier and log-rank analysis. Multivariate analysis (MVA) was analyzed by Cox proportional hazard ratio model. Results: We identified 5072 patients. Surgery and/or radiation were associated with a survival benefit. Median and 2 year survival for groups 1, 2, 3, and 4 was 7 months and 8.2%, 8 months and 8.9%, 10 months and 18.2%, and 16 months and 31.7%, respectively (p<0.00001). MVA for all patients revealed that surgery and radiation were associated with decreased mortality while T-stage, N-stage, age, signet ring histology, and peritoneal metastases were associated with increased mortality. In patients treated with surgery, MVA showed that radiation was associated with decreased mortality while T-stage, N-stage, age, removing <15 lymph nodes, signet ring histology, and peritoneal metastases was associated increased mortality. Age was the only prognostic factor in nonsurgical patients. Conclusions: Surgery and radiation are associated with increased survival in a subset of patients with metastatic gastric cancer. Prospective trials will be needed to address the role and sequence of surgery and radiation in metastatic gastric cancer.