The aim of this study was to clarify whether gastric cancer in elderly patients warrants surgical resection. Of 320 patients who underwent laparotomy for gastric cancer, 36 were older (elderly group) and 286 were younger than 75 years (control group). Clinicopathological features, mortality, morbidity, and survival were compared between the two groups. There were no differences between the two groups regarding clinicopathological features. There were no significant differences in mortality, morbidity, and the disease-specific 5-year survival rate between the two groups (elderly, 2.9%, 36.1%, and 65.7%, respectively; control, 0.7%, 24.6%, and 80.6%, respectively). The percentage of death from other diseases was 38.5% in the elderly group and 9.1% in the control group; the result was significantly higher in the elderly group (P = 0.0017). Our findings support that gastric cancer in elderly patients warrants surgical resection because the benefits with regard to early and long-term outcomes are the same as for younger patients.