Background/Aim: The extent of gastric resection and lymphadenectomy for curative treatment of distal gastric cancer remains controversial. The present study investigated the efficacy of total re;section of the lesser curvature as radical surgery for distal gastric carcinoma. Methodology: Patients with pathologically confirmed advanced distal gastric cancer seen at our hospital from 2003 to 2006 were randomly selected to receive either total resection of lesser curvature (Group A, N=60) or traditional subtotal gastrectomy (Group B, N=60), both with D2 lymph node dissection. Patient and tumor characteristics, lymph node metastases, and surgical outcomes were analyzed. Results: Three-year survival rates were 56.7% and 28.3% for Groups A and B, respectively (p=0.042). A total of 467 (30.5%) and 225 (24.7%) tumor-positive lymph nodes were resected in Groups A and B, respectively (p=0.002). Tumor recurrence rate was 1.6% (1/60) in Group A and 11.6% (7/60) in Group B (p=0.061). Conclusion: Total resection of the lesser curvature with D2 level lymph node dissection prolonged patient survival and decreased tumor recurrence. This surgical approach should be considered for the treatment of patients with distal gastric carcinoma.