Abstract: Objective To investigate the effects of enhanced recovery after surgery (ERAS) pathway on early cognitive function and postoperative recovery in elderly patients after laparoscopic gastric cancer surgery. Methods Sixty patients undergoing elective laparoscopic radical operation for gastric cancer surgery were randomly assigned into two groups:group Ⅰ and group Ⅱ, n=30 in each group. Patients in group Ⅰ received perioperative and anesthetic optimization of enhanced recovery after surgery pathway, and patients in group Ⅱ received conventional perioperative treatment. The mini-mental state examination (MMSE) was used to test the cognitive function of the patients one day before operation (T0), 24 h (T4), 72 h (T5) and 120 h (T6) after operation, and the blood concentrations of IL-6, TNF-α and IL-10 were assayed before anesthesia induction (T0), 24 h (T4), 72 h(T5) and 120 h(T6) after surgery. Results Compared with group Ⅱ, MMSE scores in group Ⅰ were increased at T4 and T5 (P<0.05), the blood levels of IL-6, TNF-α and IL-10 were decreased at T2, T3 and T4 (P<0.05). Compared with T0, MMSE scores were decreased at T4 in group Ⅰ and decreased at T4, T5 in group Ⅱ, the blood levels of IL-6, TNF-α and IL-10 in two groups were increased at T2-T4; the postoperative lengths of stay in group Ⅰ were shortened. Conclusion Enhanced recovery after surgery pathway is helpful in improving early postoperative cognitive function and decreasing the length of stay in elderly patients after laparoscopic gastric cancer surgery, and the mechanism may be related to decreased the blood levels of IL-6, TNF-α and IL-10.