Objective To explore the experience of transabdominal surgery for carcinoma of the cardia gastric base (U area). Methods All 273 cases of pancreatic gastric fundic cancer were first operated through abdominal incision, and pathological examination of the incisional margin was routinely performed to guide the scope of surgical resection, and the treatment was completed by combined thoracoabdominal incision if necessary. Gastrectomy was performed by proximal gastrectomy, total gastrectomy, and extended radical surgery including splenectomy, splenectomy + tail of pancreas, partial resection of left liver, partial resection of left liver + spleen, partial resection of left liver + spleen + tail of pancreas + transverse colon, etc. Reconstruction was performed by esophagogastric anastomosis, interposition of jejunum, and end-to-end esophageal jejunostomy. 242 cases were treated with postoperative chemotherapy with regimens of 5-Fu + CF + oxaliplatin or cisplatin, capecitabine + oxaliplatin, and single-dose capecitabine for 4 to 6 courses. Results The surgical resection rate was 95.3%, and 11 cases (4.2%) were completed by transferring the combined thoracoabdominal incision in the transabdominal surgery, and the transabdominal surgical resection rate was 91.6%. Among them, there were 80 cases of D1, 148 cases of D2 and 33 cases of D3. There were 82 cases of proximal gastrectomy, 179 cases of total gastrectomy, 35 cases of combined splenectomy, 4 cases of splenectomy + tail of pancreas, 8 cases of combined partial resection of left liver, 9 cases of partial resection of left liver + spleen, and 2 cases of partial resection of left liver + spleen + tail of pancreas + transverse colon. There were 136 cases of esophagogastric anastomosis, 49 cases of interposition jejunum, and 76 cases of jejunal Roux-en-y anastomosis with esophageal-jejunal end lateral anastomosis. There were 5 cases of postoperative anastomotic fistula and 1 case of pancreatic fistula, all of which were cured. Two cases died, and the operative mortality rate was 0.7%. 255 patients were followed up, and the follow-up rate was 97.7%, with a 1-year survival rate of 77.6%, a 3-year survival rate of 36.9%, and a 5-year survival rate of 16.1%. Conclusion Transabdominal surgical treatment of carcinoma of the cardia gastric base can achieve satisfactory efficacy as long as the indications are strictly mastered, the surgical mode and the lymph node clearance range are reasonably selected intraoperatively, combined with extended radical treatment and combined organ resection. The intraoperative pathological examination and timely transit of combined thoracoabdominal incision are helpful to avoid residual cancer cells at the proximal end of the incision.