(Disclaimer: This article is for scientific purposes only. In order to protect the patient’s privacy, the relevant information in the following content has been processed) Abstract: The patient was a male, 71 years old, who came to our outpatient clinic due to 20 days of vague pain and discomfort in the upper abdomen. The patient was at high risk for surgery because of his 5-year history of chronic kidney disease stage 6, 20-year history of diabetes mellitus, and 7-year history of hypertension. However, with the joint efforts of doctors and family members, the patient underwent laparoscopic total gastrectomy and esophagojejunal ROUX-EN-Y anastomosis. After the operation, the patient recovered well and recovered physically. Basic information] Male, 71 years old [Disease type] Gastric tumor [Hospital] The Second People’s Hospital of Hefei [Consultation time] August 2021 [Treatment] Surgery (laparoscopic total gastrectomy, esophago-jejunostomy Roux-en-Y anastomosis) [Treatment cycle] Hospitalization for 14 days, with regular outpatient follow up [Treatment effect] Surgery is good, with no serious complications, and stable perioperative creatinine level. The patient was 71 years old and came to our outpatient clinic for 20 days with vague pain and discomfort in the upper abdomen. The patient reported that he had vague pain in the upper abdomen 20 days ago, which was obvious at night, and the pain was not relieved after eating, and he had black stools for 3 times in the past month without nausea, vomiting, acid reflux, or heartburn. A CT of the upper abdomen was performed in an outside hospital, which revealed limited thickening of the gastroesophageal junction. Detailed questioning of the medical history revealed that the patient had a history of chronic kidney disease stage 6 for 5 years; a history of diabetes mellitus for 20 years with regular medication; and a history of hypertension for 7 years with regular medication. Due to the patient’s advanced age and many underlying diseases, the outpatient clinic considered that the diagnosis of gastric disease was highly likely and arranged for an electrocardiogram and gastroscopy. Gastroscopy suggested irregular huge ulcer infiltrating lesions in the cardia and gastric fundus, invading the gastric body, biopsy of two pieces of tissue, and admission as gastric tumor. After admission, the patient’s blood glucose was firstly monitored and the medication was adjusted to maintain the fasting blood glucose at 9-10 mmol/L; secondly, the patient’s blood pressure was monitored, and cardiac ultrasound, dynamic electrocardiogram and pulmonary function examination were improved to control the blood pressure, and then the patient’s blood electrolytes and renal function were monitored again, and the patient’s creatinine level was 370 μmol/L at the time of admission, and the patient’s biopsy pathology results suggested that the patient had adenocarcinoma, and enhanced chest and abdominal CCT was also improved. The patient’s biopsy pathology results suggested adenocarcinoma, and at the same time, the chest and abdomen enhanced CT was perfected, and no metastasis or recurrence of malignant tumor was found in the examination results. According to the patient’s condition, surgical treatment was recommended. However, due to the poor renal function and high risk of surgery, the family had the intention to give up the treatment, so further communication was made with the family: the patient’s renal function was poor, there were contraindications to chemotherapy, and surgery was the best treatment for the patient, which finally strengthened the family’s will to continue the treatment. Laparoscopic exploration was then arranged, and the mass was found to be located at the cardia without breaking through the plasma membrane layer, with multiple enlarged lymph nodes visible on the side of the lesser curvature of the stomach, and no metastatic nodes were seen in the liver, peritoneum and omentum. Therefore, laparoscopic total gastrectomy was performed, perigastric lymph nodes were cleared, and esophagojejunal Roux-en-Y anastomosis was performed. The whole surgical process was smooth, the operation time was 170 minutes, and there was no blood transfusion during the operation. The patient’s intraoperative bleeding was low, and her creatinine level was stable in the perioperative period. Postoperative recovery was relatively smooth, the patient had anal defecation on the 3rd day after surgery, and she was allowed to have a non-residue liquid diet on the 7th day after surgery. On the 11th day after surgery, the patient was discharged from the hospital and allowed to return home after the removal of abdominal drain. The patient was discharged from the hospital on the 11th postoperative day after the removal of the abdominal drain. After the postoperative consultation with the Department of Medical Oncology, the patient was not recommended to undergo postoperative adjuvant chemotherapy for the time being. IV. Precautions We are glad that the patient’s condition was stable after treatment, but the patient had more basic diseases before the operation, so it was necessary to control the blood sugar and blood pressure levels during the perioperative period, and at the same time, minimize the application of antibiotics and rehydration in the postoperative period. Since the patient had all of her stomach removed, postoperative nutritional control is crucial, and she should eat small meals to ensure adequate nutrition. At the same time, it is necessary to maintain sufficient sleep, do not strain, and maintain an optimistic attitude towards the treatment of the disease, which will help recovery. In addition, patients need to undergo regular review and pay attention to changes in their symptoms, such as pain, to avoid recurrence of the disease. V. Personal Insights Elderly people are characterized by the presence of more underlying diseases, which bring greater difficulties in treatment. For these patients, doctors, patients and their families need to have firm confidence in treatment in order to overcome the disease. The patient’s condition in this case is not too early, but it is the active cooperation of the family in the treatment process, coupled with the patient’s optimistic mentality, gave the basis for treatment. After surgical treatment, such patients should come to the hospital for follow-up on time and strengthen nutrition and exercise to reduce the possibility of tumor recurrence.