Purpose To evaluate the perioperative symptoms of gastric cancer patients undergoing gastrectomy using the Edmonton Symptom Assessment System Revised Japanese version (ESAS-r-J), which is a nine-item visual analogue scale to rate patient symptoms. Methods Between February 2015 and March 2017, 246 patients completed the ESAS-r-J before and after gastrectomy. We evaluated the changes in the prevalence and score of each ESAS-r-J item before and after gastrectomy. In addition, we compared them after gastrectomy between patients who underwent the different approaches. Results Before gastrectomy, anxiety and well-being were the most prevalent items (80%), followed by depression (45%). After gastrectomy, well-being was the most prevalent item (87%), followed by pain (68%). The prevalence of anxiety decreased from 80% to 59% (P = 0.002). The depression and anxiety scores decreased from 1.6 to 1.1 (P < 0.001) and from 2.6 to 1.7 (P = 0.002), respectively. The total score was higher in patients who underwent open surgery than in patients who underwent laparoscopic surgery (16.9 vs 12.9 ; P = 0.031). Conclusions After gastrectomy, psychological symptoms such as depression and anxiety improved despite more physical complaints than before gastrectomy. The laparoscopy was less invasive. It is very important to take care of psychological aspects before gastrectomy. J. Med. Invest. 68 : 90-95, February, 2021