Abstract: Objective   To investigate the clinical outcome of laparoscopic D2 radical distal gastrectomy in the treatment of elderly patients with advanced gastric cancer，and to investigate its effect on the expression of peritoneal lavage levels of dopamine Decarboxylase(DDC)，Hypoxia Inducible Factor1α(HIF1α)and serum levels of hypoxiainducible factor1α(HIF1α)，metastasis associated with colon cancer 1(MACC1).Methods  120 cases of elderly patients with advanced gastric cancer undergoing radical gastrectomy were divided into laparoscopic group(n=60)and open group(n=60)，patients received laparoscopic and open D2 radical distal gastrectomy respectively in the two groups.The perioperative conditions，survival，recurrence and metastasis rate between the two groups were compared.The serum levels of HIF1α，MACC1 and peritoneal lavage levels of CEA and DDC were measured preoperatively and postoperatively.Results  The operative time，number of lymph nodes dissected,length of proximal margin to the cancer，length of distal margin to the cancer and postoperative complication rates in laparoscopic group〖LM〗were(163.05±15.41)min，26.89±4.55，(7.04±1.13)cm，(6.13±1.04)cm and 3.33%，respectively，which were no significant differences with open group[(158.23±13.44)min，28.41±5.23，(7.22±1.28)cm，(6.02±1.13)cm，11.67%](P>0.05).The length of incision，intraoperative bleeding，postoperative flatus time，diet intake time，ground activity time and hospital stay in laparoscopic group were(5.23±1.26)cm，(155.01±30.21)ml，(4.12±0.65)d，(4.15±0.71)d，(2.91±0.44)d，(12.69±2.45)d，respectively ，which were significantly lower than(16.32±2.53)cm，(351.91±42.16)ml，(5.13±1.02)d，(5.22±1.14)d，(4.82±1.13)d，(18.12±4.43)d in the open group(P<0.05).The peritoneal lavage levels of CEA，DDC and serum levels of HIF1α，MACC1 after operation in laparoscopic group were(1423.49±331.56)ng/ml，(115.03±30.21)ng/ml，(45.02±10.03)pg/ml，(76.69±12.45)pg/ml,respectively ，which were significantly lower than open group[(2812.43±702.48)ng/ml，(168.40±47.19)ng/ml，(61.45±15.44)pg/ml，(104.46±15.96)pg/ml](P<0.05).The 1，3and 5year survival rates were respectively 96.49%，83.64% and 60.87% in laparoscopic group，showed no significant differences with open group(94.55%，80.77%，59.52%)(P>0.05).There was no significant difference in the average postoperative survival time between the two groups(P>0.05).The recurrence and metastasis rate was 14.04% and 25.45% in laparoscopic and open group，respectively(P>0.05).conclusion  Laparoscopic and open D2 radical distal gastrectomy had similar radical effect in the treatment of elderly patients with advanced gastric cancer，while laparoscopic surgery has the advantages of minimally invasive and rapid postoperative recovery and may reduce the risk of micrometastasis.