Objective  To evaluate the safety of laparoscopy-assisted distal gastrectomy on elderly patients (≥70 years old). Methods  The prospective cohort study was adopted. A total of 100 elderly patients with malignant gastric cancer were selected and randomly divided into laparoscopy group (n=50) and open surgery group (n=50). The operation time, intra-operative blood loss, post-operative flatus time, hospital stay, complications (anastomotic leakage and post-operative cardiopulmonary complications), peripheral blood leukocyte count, and C reactive protein of two groups were compared. Results  The difference of operation time of two groups was not significant (P=0.086), while the differences of intra-operative blood loss (P=0.016), post-operative flatus time (P=0.000), and hospital stay (P=0.000) of two groups were statistically significant. For laparoscopy group, there were 2 cases of anastomotic leakage and 6 cases of cardiopulmonary complications. For open surgery group, there were 3 cases of anastomotic leakage and 5 cases of cardiopulmonary complications. The differences of C reactive protein and leukocyte of two groups 1, 3, and 7 d after surgery were significant (P=0.000). Conclusion  Laparoscopy-assisted distal gastrectomy is more safe and feasible than open surgery for the treatment of elderly patients with distal gastric cancer in terms of intra-operative blood loss, postoperative flatus time, post-operative hospital stay, and post-operative inflammatory factors.