The technique of totally laparoscopic total gastrectomy (TLTG) has been developed for gastric cancer, but its feasibility and surgical outcomes remain unclear. This is the first study comparing the early surgical outcomes of TLTG with those of conventional open total gastrectomy (OTG) for gastric cancer.Between January 2011 and December 2011, 139 patients underwent TLTG, and 207 patients underwent OTG for gastric cancer; surgical procedures were selected by means of preoperative diagnostic tests under T3N2M0. Clinicopathologic characteristics and early surgical outcomes in the two groups were compared retrospectively.There were no significant difference in preoperative characteristics between the two groups, and the durations of surgery were not significantly different. However, TLTG was superior to OTG in terms of time to first flatus, time to commencement of soft diet, pain score (visual analog scale), need for analgesics, length of hospital stay, and overall postoperative complications (each P<.05). The median number of lymph nodes harvested was significantly higher in the TLTG group (37 versus 34; P=.039). Resection margins were negative in all patients.TLTG should be considered as a safe and practicable alternative to OTG for the treatment of gastric cancer. Moreover, it is less invasive and results in faster recovery than OTG.