Background: Although there are several traditional treatment modalities for stage IV gastric cancer including chemotherapy, radiation therapy, palliative surgery, or best supportive care, survival result is unsatisfactory. Recently, gastrectomy after chemotherapy which is called conversion surgery or adjuvant surgery was introduced. Methods: In total, 419 patients who were diagnosed stage IV gastric cancer from 2010 to 2015 in eight Catholic Medical Center affiliated hospitals were divided into four groups; 212 for chemotherapy only group (G1), 124 for chemotherapy after primary gastrectomy group (G2), 23 for gastrectomy after chemotherapy group (G3), and 60 for best supportive care group (G4). To compensate chemotherapy effects, cases of complete remission, partial response, and stable disease were selectively analyzed. To identify the factors that affected survival rate, the result of surgery and the intent of surgery of the G3 were analyzed. Results: Three-year survival rate of the G3 was significantly higher than that of the G1 (42.8% vs 12.0%, p = 0.001). In case of the patients with a response to chemotherapy, three-year survival rate showed similar result (G3 vs G1, 46.1% vs 18.4%, p = 0.011). In the G3, R0 resection and curative intent of resection showed better three-year survival rate (R0 vs R1 or R2, 61.1% vs 16.2%, p = 0.003, curative vs palliative, 62.3% vs 23.8%, p = 0.031). Conclusions: The present study showed that gastrectomy after chemotherapy might improve the survival rate for the patients with stage IV gastric cancer, especially who could undergo R0 resection.