Abstract: AIM To compare the surgical safety, postoperative complications and hospitalization expenses of laparoscopyassisted pylorus and vagus nerve-preserving gastrectomy (LAPPG) and distal gastrectomy (LADG) in order to evaluate the feasibility of LAPPG in the treatment of middle-third early gastric cancer.METHODS The clinical and pathological data, surgical procedure, postoperative outcomes and hospitalization expenses of 112 patients with middle-third early gastric cancer treated from June 2016 to August 2017 at Department of Gastrointestinal Surgery of Renji Hospital were analyzed retrospectively. Forty-six patients received LAPPG, and 66 cases underwent LADG. RESULTS There were no significant differences between the two groups in age, sex, BMI, tumor differentiation, operative time, estimated blood loss, tumor diameter, resected lymph nodes, or metastatic lymph nodes (P> 0.05). Proximal and distal resection margins were significantly shorter in the LAPPG group than in the LADG group (P< 0.05). For postoperative outcomes, there were no significant differences in hospital stay, time to first flatus, time to gastric tube removal, time to first ambulation, time to first fluid diet, or postoperative complications (≥Dindo grade Ⅱ) (P> 0.05). Hospitalization expense of LAPPG was significantly lower than that of LADG [4.6 ±0.5 vs 5.3 ± 0.4 (ten thousand yuan), P = 0.004].CONCLUSION On the premise of oncologic safety and efficacy, LAPPG is a cost-effective and feasible treatment for middle-third early gastric cancer.