Background: This study aimed to compare the clinical outcomes of endoscopic submucosal dissection (ESD) and surgery for the patients with early gastric cancer (EGC). Methods: Data of 79 EGCs in 76 patients treated with ESD and 59 EGCs in 57 patients treated with surgery between 2005 and 2015 were analyzed retrospectively. We only included EGCs confined to the mucosal layer. Demographic data, pathologic data, complication, 5-year overall survival (OS) data were collected. Results: The clinicopathological characteristics of the patients were shown in Table 1. The mean follow-up periods were 31.5 months (5-96 months) for ESD group and 68.4 months (1-139 months) for surgery group (P < 0.001). One patient (1.9%) in ESD group has experienced metachronous tumor, but there was no patient who had recurrence tumor or metastasis in surgery group. The 5-year OS rates did not differ between two groups (91.2% in ESD group versus 87.4% in surgery group, respectively; P = 0.490 by log-rank test). The early complication rates happened within 3 months of procedure were similar in both groups (P = 0.501). However, the late complication rates were significantly higher in surgery group than those in ESD group (P = 0.002). Conclusions: The clinical outcomes after ESD including 5-year OS were comparable to those of surgery. Regarding the late complication, ESD was superior to surgery.