There is a widespread belief that nasogastric decompression in gastric cancer surgery allows better surgical field and leads to the reduction of postoperative complications. The aim of this study was to evaluate whether gastric cancer surgery can be safely performed without nasogastric decompression. From March to June 2000, 119 patients with gastric adenocarcinoma were randomized into either a tubeless group (n=56) or an intubated group (n=63). Exclusion criteria included a history of upper gastrointestinal bleeding and pyloric obstruction. No remarkable difference was found in the incidence of complications in the tubeless and intubated groups (mean 10.9%, p=0.945). The incidence of nasogastric tube insertion in the tubeless group was similar to the incidence of nasogastric tube reinsertion in the intubated group (p=0.747). Time to pass flatus was not different in the two groups (p=0.054), nor was the length of hospital stay (p=0.148). These results suggest that gastric cancer surgery can be performed safely without nasogastric decompression.