This study includes patients diagnosed with proximal gastric cancer (Siewert type II/III, cT1-3N0-1M0) across six tertiary hospitals, who underwent either double-tract reconstruction (DTR) or tubular gastric anastomosis (TGA). Participants were divided into two groups based on the surgical procedure. We conducted a comparative analysis of postoperative outcomes by evaluating electronic medical records, postoperative gastroscopy, 24-hour esophageal pH monitoring, and relevant rating scales.

Inclusion Criteria:

• Pathologically confirmed gastric adenocarcinoma by biopsy
• Carcinoma of the upper gastric body or Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG), with a clinical stage of cT1-3N0-1M0
• Age 18-75 years, with a performance status (PS) score of 0-2
• Candidates for planned surgical resection, eligible for either double-tract reconstruction or tubular gastric anastomosis based on preoperative assessment
• No severe dysfunction of vital organs (liver, kidney, heart, lung, or brain), and no severe infection or uncontrolled chronic diseases

Exclusion Criteria:

• Presence of other malignant tumors or severe chronic diseases (e.g., severe diabetes mellitus, chronic kidney disease, decompensated cirrhosis, etc.)
• Preoperative endoscopic diagnosis of Barrett's esophagus
• Severe preoperative malnutrition (albumin <30 g/L, prealbumin <150 mg/L)
• History of prior upper abdominal surgery, gastrointestinal malformation, or psychiatric disorders
• Preoperative diagnosis of obstructive motor disorders of the cardia (including achalasia spectrum disorders)
• Inability to cooperate with or complete the required postoperative examinations