180 Background: To evaluate the short- and long-term effects of two different surgery approaches for remnant gastric cancer after distal gastrectomy. Methods: Clinical data of 48 remnant gastric cancer patients were collected retrospectively from the period of January 1st 2010 to December 31st 2012 in this matched-pair study. Twenty four patients in the experimental group underwent radical surgery in antegrade approach (starting from the esophagus to the gastrointestinal anastomosis), another 24 matched patients in the control group underwent radical surgery in retrograde approach (starting from the gastrointestinal anastomosis to the esophagus). Constants in the study were patient age, the operating surgeon, Borrmann type, TNM stage and operation range. Pearsonχ2 testor t-test were used to compare the clinicopathological characteristics between the two groups. Survival rates of 1- and 3-years were analyzed with Kaplan-Meier survival curve and compared with Log-rank test. Results: The 48 patients were treated successfully without any mortality during their hospital stay. The mean operative time and bleeding volume in the experimental and control groups were (126.6±5.7) min and (154.1±23.9)ml , and (168.3±11.7) min and (180.8±15.0)ml respectively. The difference in the mean operative times (t = -3.089, P = 0.005) and the mean bleeding volumes (t = -3.269, P = 0.004) were statistically significant. The average hospital stay after surgery and the average number of lymph nodes resected were (9.5±0.9) days and 18.7±1.6 in the experimental group,(9.2±0.8) day and 17.4±1.4 in the control group. There was no statistical differences between the two groups in terms of the average hospital stay (t = 0.692, P = 0.496) and the average number of resected lymph nodes (t = 2.101, P = 0.247). The overall 1- year and 3-years survival rates were 75%, 49% in the experimental group and 67%, 35% in the control group. There was also no statistical difference in the 1-year (P = 0.745) and 3-years (P = 0.878) survival rates. Conclusions: Compared with retrograde approach, performing radical surgery in antegrade way for remnant gastric cancer patients can shorten the operation time, reduce blood loss and simplify the operation procedure.