Purposes Laparoscopy-assisted gastrectomy (LAG) for clinical early (cT1) gastric cancer (EGC) is superior to open gastrectomy in terms of the short-term outcome; however, long-term survival outcome remains elusive. Methods Four hundred and ninety-one cT1 EGC patients who underwent LAG between 1998 and 2010 were registered to evaluate the survival outcome, including 237 patients who were observed for at least 5 years (long-term, L group), while 221 patients who were observed for at least 2–5 years (intermediate term, I group). Results There were 17 deaths, including 7 patients who developed recurrence (5 in pT1 and 2 in pT4a). Two fatal cases with pStage IIB were uniquely T1N3b. Six out of the 7 recurrences occurred within 2 years after surgery. The 237 patients in the L group included 6 of the recurrent deaths (2.5 %), while the 221 patients in the I group included 1 recurrent death (0.9 %). Recurrent sites of pathological T1 cases were the liver ( n  = 2), lung ( n  = 1), ovary ( n  = 1), and bone ( n  = 1), and no peritoneal or local recurrence was found. Conclusions Collectively, the survival outcome of EGC by LAG was excellent and LAG was acceptable as a therapeutic procedure for EGC.