Cardia cancer belongs to the tumor of esophagus-gastric combination, surgery is the only means to cure this disease, and the mainstream surgery for cardia cancer is total gastrectomy. Many patients or their family members will have a question: Is it necessary to do total gastrectomy for cardia cancer? Before answering this question, we need to popularize what is radical gastrectomy for gastric cancer. The so-called radical surgery is a kind of curative surgery, and for gastric cancer, it simply means removing the lesion and the stomach wall that may be involved, and removing the lymph nodes around the stomach that may be metastasized. The lymph nodes around the stomach are numbered as 1-16 groups according to their different locations, and are divided into 1-3 stations according to the distance of the lymph nodes from the tumor. Standard radical gastric cancer surgery requires the removal of lymph nodes up to station 2 (the so-called D2 clearance), while lymph nodes of the cardia or the upper third of the upper gastric cancer (groups 5 and 6) belong to station 3, which is not a part of the scope of the standard radical operation, and the scope of resection for the gastric wall in general requires that In general, the resection range of the stomach wall requires that ≥5 cm from the tumor margin is sufficient, so cardia or upper 1/3 gastric cancer can be completely treated with proximal gastrectomy. （Therefore, total gastrectomy is completely acceptable for cardia cancer or upper 1/3 gastric cancer. (In short, early cardia cancer or upper 1/3 gastric cancer can be cleaned up with proximal gastrectomy) If so, why is total gastrectomy the mainstream operation for cardia cancer? Here we need to learn another key point of gastric cancer surgery: digestive tract reconstruction. The so-called reconstruction of digestive tract after gastric cancer surgery is: after partial or total removal of stomach, the continuity and integrity of digestive tract is damaged, and it is necessary to reconnect the proximal and distal digestive tracts of the resected part, so that the patient can eat normally after the surgery. Sweeping determines the effect of radical treatment, and reconstruction determines the quality of life, and both are indispensable. (It has been reported that preservation of part of the stomach is helpful in improving the quality of life and nutritional absorption in the long term.) By removing the proximal stomach, the function of the distal stomach is naturally preserved. However, the mainstay of traditional reconstruction is the esophagogastric anastomosis, which has a serious physiological drawback – the loss of the cardia’s anti-reflux function means that gastric juices (which are acidic) will naturally reflux into the esophagus, leading to reflux esophagitis (GERD). The main symptoms include: retrosternal pain, acid reflux, heartburn, etc. Symptoms worsen when lying down and nighttime sleeplessness, which seriously affects the quality of life, and patients with severe symptoms may even ask for removal of the remaining stomach. So people have come up with many ways to reduce reflux on the basis of retaining the remnant stomach, such as adding a section of jejunum between the remnant stomach and the esophagus – double channel, jejunal interposition. These methods are effective in combating reflux, but the surgery is very complicated, so most surgeons prefer total gastrectomy for cardia cancer (taking into account oncological safety and surgical safety).