The Authors in this work study a comparison between 27 patients who underwent total gastrectomy with "regional" lymphadenectomy for gastric cancer during the period 1986-1991 (Group A), and 27 patients who underwent total or sub-total gastrectomy associated to D2 or D3 lymphadenectomy (Group B) according to the rules of the Japanese School (localization of the neoplasia and node involvement). No statistically relevant differences were shown in the overall long term survival, although in the group B there were both an high number of patients with stage III neoplasia and more invasive carcinomas. Extended lymphadenectomies, regional and D2 or D3, gave good results as far as long term survival was concerned in early stage cancers, but the same success was not achieved in advanced cancers especially in stage III. In order to improve the survival in advanced neoplasias since one year a D4 lymphadenectomy is performed in T2 or T3 and/or N2+ cases.