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Background: The prognosis of patients with gastric carcinoma with invasion of the adjacent organs (T4 gastric carcinoma) is very poor. We evaluated the survival benefit of resection in this group of patients. Method: We retrospectively reviewed the hospital records of 288 patients with T4 gastric carcinoma to compare the clinicopathological results in patients with curative resection ( n = 95) with patients with non-curative resection ( n = 193) during the period 1986–2000. Results: With a 33% curative resectability in patients with T4 gastric carcinoma, patients with tumour resection (curative and non-curative) had a significantly improved survival rate. The overall survival rate was higher for patients who underwent resection (11.6%) than for patients who were not resected (2.5%), regardless of curability ( P < 0.001). Using Cox’s proportional hazard regression model, lymph node invasion and curability were independent statistically significant prognostic parameters. The prognosis of patients with invasion to the peritoneum and adrenal glands was significantly poorer than that of patients in whom there was no such invasion. But, the number of organs invaded had no effect on patient survival. Conclusions: Patients with T4 gastric carcinoma might be benefited from curative resection. The results also emphasize the improved survivorship of T4 gastric carcinoma patients with resection compared with those who did not undergo resection. Although curative resection cannot be undertaken in patients with T4 gastric carcinoma, we recommend performing resection in patients with locally advanced gastric carcinoma, regardless of curability. [ABSTRACT FROM AUTHOR]