BACKGROUND: Laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) was known to have benefits of function-preserving surgery compared to laparoscopy-assisted distal gastrectomy (LADG). However, in clinical settings, delayed gastric emptying and esophageal reflux following LAPPG can be serious issues, making surgeons reluctant to perform LAPPG. It is unclear that LAPPG had better long-term functional outcomes and quality of life compared to LADG. AIM: To evaluate the long-term functional outcomes and patient-reported quality of life of LAPPG compared to those of LADG. METHODS: We reviewed the clinicopathological data of 195 patients who underwent LADG with Billroth II anastomosis and 101 patients who underwent LAPPG for cT1N0 gastric cancer in the middle third of the stomach between 2012 and 2015. Postoperative complications, nutritional parameters, and survey results of the European Organization for Research and Treatment of Cancer Questionnaire C30 and STO22 questionnaire were compared between the two groups. RESULTS: The serum hemoglobin level was significantly higher in the LAPPG group than in the LADG group ( < 0.001). In the endoscopic findings, incidence of bile reflux was lower ( < 0.001); however, the incidence of residual food was higher in the LAPPG group than in the LADG group ( < 0.001). Regarding the quality of life score, the LAPPG group had a better physical functioning score (86.7 90.0, = 0.032) but also greater pain and reflux when compared to the LADG group [8.3 16.7 in pain, 11.1 (interquartile range, 0, 22.2) 11.1 (interquartile range, 11.1, 33.3) in reflux, = 0.034 and 0.001, respectively]. CONCLUSION: LAPPG is beneficial to recovery of anemia and to bile reflux, however, it might be unfavorable in terms of pain and reflux symptoms compared to LADG with Billroth II anastomosis.