Objective: To compare the short-term efficacy of totally laparoscopic gastrectomy (TLG) and laparoscopy-assisted gastrectomy (LAG). Methods: The data of 435 patients with gastric cancer treated in the Department of Gastrointestinal Surgery of the Second Affiliated Hospital, Nanchang University from May 2013 to May 2016 were collected. Of the patients, 207 cases underwent TLG (TLG group), and 228 cases underwent LAG (LAG group). The main clinical variables between the two groups of patients were compared. Results: The preoperative data between the two groups of patients were comparable, and operations were successfully performed in all cases without any open conversion. In TLG group compared with LAG group, the number of resected lymph nodes showed significant difference (23.64 vs. 24.69, P=0.14), while the operative time (204.34 min vs. 214.65 min), anastomosis time (33.00 min vs. 38.86 min), intraoperative blood loss (185.20 mL vs. 210.02 mL), and the incision length (3.88 cm vs. 8.05 cm), time to postoperative ambulation (1.71 d vs. 2.59 d), time to first gas passage (2.63 d vs. 3.51 d), the first and third day postoperative pain score (3.01 vs. 4.86; 1.88 vs. 3.53), and length of postoperative hospital stay (12.23 d vs. 15.96 d ) were all significantly reduced (all P<0.05). There were no significant differences in incidence of postoperative complications (2.4% vs. 2.6%, P=0.89) and median survival time during a 12-month follow-up (11.07 months vs. 10.91 months). Conclusion: TLG is safe and effective, and its short-term efficacy in superior to that of LAG.