Gastric cancer is the third most common cancer worldwide. Early gastric cancer (EGC) is an invasive gastric adenocarcinoma that invades no more deeply than the submucosa with or without lymph node metastasis irrespective of the tumor size. Gastric cancer may manifest in a variety of histologic, anatomic, and genetic patterns, which influences the surgical approach and requires a customized and multimodality treatment plan for each patient. Gastrectomy remains the treatment of choice for patients with early gastric cancer that are not suitable for endoscopic treatment or in the case of non-curative endoscopic resections. Over the last decade, laparoscopic gastrectomy has gradually gained popularity as a surgical option for distal early gastric cancer. Although an open surgical approach should be applied for any case with concerns of respectability of the cancer lesion, the safety margin, or capability of operating surgeons, it appears that the minimally invasive surgical approach can be here to stay. The aim of the current article to review the different surgical options for the treatment of EGC. As the indications are continued to expand to treat more advanced tumors and with the supporting data from the additional prospective studies to clearly define the ontologically appropriate application of laparoscopic gastrectomy.