Aim. Aim of the study was to compare the long term results of laparoscopic and open gastrectomy for advance gastric cancer. Methods. from February 2000 to January 2004 all patients with adenocarcinoma of the stomach were assessed to entry in this longitudinal prospective non randomized trial. Patients agreed to receive either a laparoscopic or laparotomic approach. They were assigned to one or the other procedure at the multi-disciplinary meeting on the solely base of the availability of an upper gastro-intestinal surgeon expert in advance laparoscopic surgery and anyway trying to alternate the 2 procedures.Adjuvant therapy was similar in both groups. The primary endpoint was cancer related survival and secondary endpoints were overall survival, evaluation of surgical complications and mortality, and time to return to normal activity. Patients completed an appropriate health profile questionnaires for the latter of secondary endpoints. Fisher’s exact test, Student’s t-test and Kaplan-Meyer survival analysis were used where appropriate for statistical analyses.Results. Fifty-one patients were enrolled in the protocol of study. Population of study was homogeneously distributed in the two groups. Eight patients were excluded from the analysis of primary endpoint: 5 because of findings during initial exploratory surgery and 3 who died within 90 days from surgery. Forty-three patients were followed-up (range 11-104, mean 44 months). Five patients were lost at F.U. Twenty-one patients underwent a laparoscopic gastric surgery (LGS) and 22 had a standard open procedure (OGS). No statistical difference was found between the two groups in terms of 5 years cancer related survival (44% vs 45%, p 0.9), and 5 years overall survival (39% vs 50%, p 0.9). We found no differences in surgical complications and postoperative mortality in the 2 groups. Operative time was significantly longer for LGS (p<0.001). There was no conversion to open surgery in this series. Health-profile questionnaires’ assessment is still in progress. However preliminary results seems to favor the laparoscopic approach.Conclusions. LGS is as effective as OGS in the treatment of advanced gastric cancer. There was a tendency of higher limitation of patient’s day-life in the immediate and late postoperative period in the OGS group. Based on these results, the authors cannot recommend routine use of LGS over OGS for the treatment of advanced gastric cancer.