Objective: To investigate the influence of HBsAg state on survival rate of the patients with gastric liver metastases after synchronous resection. Methods: The systematic follow-up data for 5 years of 31 patients with gastric liver metastases undergoing combined resection of the stomach and liver during recent 10 years were retrospectively analyzed. The survival curves were calculated by Kaplan-Meier method and Log-rank test was used to determine the significance of the survival rates. Multivariate analysis was performed by using Cox's proportional hazards model. Results: Of the 31 patients, 29 cases had a complete systemic follow-up, so the follow-up rate was 93.5%. In the 29 follow-up patients, 3 cases survived without recurrence and 26 cases died due to disease recurrence or metastasis. The 1-, 3- and 5-year cumulative survival rates for the whole group were 62.1%, 22.4% and 12.1%, respectively. The 1-, 3- and 5-year cumulative survival rates for the HBsAg positive patients (14 cases) were 58.4%, 18.7% and 8.9%, and for the HBsAg negative patients (17 cases) were 69.3%, 27.9% and 15.7%, respectively. HBsAg negative patients had better survival chance than HBsAg positive ones (χ2=2.119, P=0.034). The results of multivariate analysis indicated that the risk of death of the HBsAg positive patients after surgery was 1.670 times that of the negative ones, and in addition, the size of liver metastasis and the type of surgical procedure for gastric cancer were independent risk factors for survival (RR=2.121, 95%CI=1.864– 2.378; RR=2.296, 95%CI=2.001–2.591). Conclusion: HBsAg is an independent prognostic factor for patients with gastric liver metastasis after synchronous resection. Therefore, HBsAg status should be taken into account when planning such operations.