Gastrectomy with D2 lymphadenectomy is the standard surgical procedure in most hospitals in Peru due to the fact that this Japanese surgical technique has proven to provide the best results in the world. However, no comparative study of the results of D1 and D2 lymphadenectomies has ever been performed in our country. This retrospective cohort study compares D2 lymphadenectomy versus D1 in surgical treatment of gastric cancer.Between January 2000 and December 2002, 316 patients underwent surgery at the Rebagliati National Hospital and a total of 100 patients were randomly selected, 50 of which underwent a D1 lymphadenectomy and 50 a D2 lymphadenectomy.Mortality rates were 8% for D1 lymphadenectomy and 4% for D2, whereas morbidityrates were 24% for D1 and 12% for D2. Survival after 3 years was 36% for D1 and 56% for D2 thus establishing a statistically significant difference (p = 0.04).We recommend gastrectomy with D2 lymphadenectomy as the surgical treatment of choice for advanced gastric cancer.