Objective To explore the efficacy and safety of the laparoscopic-endoscopic cooperative surgery combined sentinel lymph node navigation surgery (LECS-SNNS) strategy in early gastric cancer (EGC) patients with different indications. Methods A retrospective analysis was conducted on the clinicopathological data of 60 consecutive EGC patients who underwent LECS-SNNS at Beijing Friendship Hospital, Capital Medical University, between August 2023 and November 2025. Among them, 13 patients underwent endoscopic submucosal dissection (ESD) combined with laparoscopic sentinel lymph node basin dissection (LSBD) (ESD-LSBD group); 30 received laparoscopic-endoscopic regional gastrectomy (LRG) combined with LSBD (LRG-LSBD group); and 17 underwent LSBD alone (LSBD group). Clinicopathological characteristics, gastric emptying time, nutritional status, quality of life (QoL), and perioperative complications were analyzed and evaluated. Results Four patients were converted to standard D2 radical gastrectomy due to sentinel lymph node metastasis. Except for a significantly higher proportion of pT1b (73.3%) stages in the LRG-LSBD group than in the other two groups (P<0.05), no statistically significant differences were observed among the three groups regarding baseline characteristics and the number of detected lymph nodes. Regarding perioperative indicators, the LSBD group had a significantly shorter operative time than the LRG-LSBD group (P=0.001) and a markedly shorter postoperative hospital stay than the other two groups (both P<0.017). Intraoperative blood loss in the LSBD and ESD-LSBD groups was significantly lower than that in the LRG-LSBD group (both P<0.017). The gastric half-emptying time at 1 week postoperatively was significantly longer than the preoperative baseline across all three groups, which markedly improved at 3 months postoperatively, showing no statistically significant difference compared with the preoperative baseline. At 1 week postoperatively, the gastric half-emptying time in the LSBD group was significantly better than that in the LRG-LSBD group (P<0.017), whereas no significant difference was found among the groups at 3 months postoperatively. Most nutritional indicators in each group decreased significantly at 1 week postoperatively and returned to preoperative levels at 3 months postoperatively, with no significant differences observed among the groups. Regarding QoL, scores for most indicators declined significantly at 1 month postoperatively and recovered to preoperative levels at 3 months postoperatively. At 1 month postoperatively, the LSBD group demonstrated significantly better indigestion symptom scores and total symptom scores in the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) than the LRG-LSBD group (P<0.017), while differences in other scales and postoperative scores among the groups were not statistically significant. Within 90 days postoperatively, two complications occurred (one grade I and one grade II), both of which resolved after conservative treatment; no complications of grade ≥ III were observed. Conclusion LECS-SNNS strategy for EGC provides a safe, individualized treatment selection through accurate preoperative assessment and intraoperative lymph node navigation, achieving oncological R0 resection while effectively maximizing short-term organ function and quality of life preservation.