Objective To determine the effect of different anesthetic approaches on postoperative pulmonary infection in the elderly patients after gastric cancer surgery. Methods A total of 100 elderly patients with gastric cancer who were treated surgically in our hospital from March 2013 to March 2016 were recruited in this study. They were randomly divided into total intravenous anesthesia group (TIVA, n=32), inhalation anesthesia group (IA, n=30), and combined epidural-intravenous anesthesia group (CE-IVA, n=38). Respiratory rate (RR), blood oxygen saturation (SaO₂) and minute ventilation (MV) were measured before anesthesia and in 5 min after extubation. The recovery time and extubation time were monitored after the operation was finished. On the 3rd day after operation, the incidence of postoperative pulmonary infection was observed in the subjects. Results Significantly elevated RR and reduced SaO₂ and MV were observed in all the 3 groups of patients after extubation than before surgery (P<0.05). The CE-IVA group had obviously lower RR, higher SaO₂ and MV, shorter recovery time and extubation time, and lower incidence of pulmonary infection when compared with the other 2 groups (P<0.05). Conclusion Combined epidural-intravenous anesthesia can improve respiratory function and reduce the incidence of postoperative pulmonary infection in elderly patients after gastric cancer surgery.