Purpose: We compared the changes in the perioperative peripheral lymphocyte subsets and the acute inflammatory reactants (CRP and SAA) to compare the immune responses between a Laparoscopy-assisted distal gastrectomy (LADG) and a conventional open distal gastrectomy (CODG). METHODS: 23 patients, who underwent an operation for early gastric cancer, between Nov. 2003 and Feb. 2004, were enrolled in this study. The total WBC, lymphocytes, peripheral lymphocyte subsets and acute inflammatory reactants (CRP and SAA) were evaluated on the preoperative day, and 2, and 24 hrs and on the 4th postoperative day in 20 of the 23 cases. RESULTS: There were no significant differences in the preoperative total WBC, lymphocyte, peripheral lymphocyte subsets, CRP and SAA between the two groups (P <0.05). The WBC levels were highest 2 hours after surgery, but had decreased at 24 hrs and on the 4th postoperative day in both groups. The numbers of lymphocyte subsets in both groups dropped at 2 hours, but increased gradually during the postoperative days (P >0.05). The postoperative CRP and SAA levels; however, gradually increased compared to the preoperative levels, and were significantly lower in the LADG than the CODG group (CRP: P=0.03 and SAA: P=0.01). Conclusion: No difference was detected in the immune-cell numbers in the gastric cancers between the LADG and CODG groups. The LADG was found to influence the acute inflammatory reaction less than the CODG.