1. Indications for surgery. To date, surgery is recognized as the treatment of choice for cardia cancer. Since its histology is adenocarcinoma or mucinous adenocarcinoma, radiation therapy is almost ineffective and chemotherapy has little effect. Indications for cardia cancer surgery: ① Confirmed by X-ray, cytology and endoscopy; ② Except lymph node, liver, adrenal gland, omentum, peritoneum and pelvic cavity metastasis by ultrasonography, abdominal CT scan or laparoscopy, without ascites; ③ Above moderate general condition, without major cardiopulmonary or other organ comorbidities. 2.The commonly used surgical method is subtotal proximal gastrectomy. It is suitable for cardia tumors with small size, and the invasion along the lesser curvature does not exceed 1/3 of its total length. Surgical operation is as follows: open the chest in the left posterior external 7th rib bed or intercostal, explore the lower esophagus, then cut the diaphragm and explore the abdomen to the left anteriorly on the axis of the cleft hole, and when there is no liver, peritoneal metastasis or extensive lymph node metastasis, disconnect the greater omentum, left gastric omental artery and gastric short artery in the gastrosplenic ligament along the greater curvature and disconnect the left diaphragm foot to reveal the lower esophagus completely, and remove lymph nodes from this area (including the lower pulmonary ligament). The body and tail of the pancreas were opened with gauze pads, the left gastric vessel and its nearby lymph nodes were revealed, the lymph nodes were carefully cleared, the left gastric vessel was ligated and severed, the hepatogastric ligament was dissected, and the proximal stomach was completely free, and the gastric tube was cut on the side of the greater curvature, and the gastric stapler, if available, could save the operation time. The cut edge is not <5 cm from the tumor edge. the gastric tube is rotated clockwise by 90°, and then anastomosed with the lower esophageal stump end to end. the inner layer is a full-layer nodal suture, and the outer layer will be the gastric plasma musculature upward to encircle the anastomotic opening for about 2 cm, such as telescope shape. Before anastomosis, in order to prevent the mucosa of the gastric orifice from being too long, and to affect the anastomotic operation by covering the side of the muscular layer externally, the muscular layer of the mouth of the gastric tube can be cut open in a circular manner, and the loose mucosa at this time can be exposed as a sleeve due to the retraction of the muscular layer of the distal side. The submucosal layer is sufficiently hemostatic, and the excess mucosa is cut off at the plane of the distal muscularis layer. At this time, the mucosa of the mouth of the gastric tube is exactly level with the muscularis layer, and the field of vision is very clear during the anastomosis, which is helpful for the tight alignment. When the tumor infiltrates more than half of the length of the lesser curvature of the stomach, total gastrectomy is required, and the blood supply of all 5 groups of stomachs needs to be cut off. After total gastrectomy, the duodenal end is sutured, and esophageal jejunum anastomosis is performed. The simplest is esophagojejunostomy, jejunojejunostomy, or Roux-Y esophagojejunostomy, jejunojejunostomy. The authors concluded that the former operation is simpler and the jejunal blood flow is better preserved than the latter. If the tumor has invaded the gastrosplenic ligament or the tail of the pancreas, the spleen and tail of the pancreas can be resected at the same time of subtotal or total gastrectomy. Attention should be paid to properly suture the cut surface of pancreas, and it is better to cover it with omentum to prevent pancreatic duct fistula. 3.Surgical treatment near and long term efficacy. The surgical efficacy of cardia cancer is worse than esophageal cancer. The resection rate of the three major groups in China is 73.7%~82.1%, and the resection mortality rate is 1.7%~2.4%. The 5-year survival rate of the three major groups was 19.0%~24.0%, and the 10-year survival rate was 8.6%~14.3%. The main factors affecting the long-term survival of cardia cancer are the presence or absence of lymph node metastasis, whether the tumor infiltrates the plasma membrane and the nature of resection (radical or palliative). The international TNM staging of cardia cancer is also an effective indicator for predicting patient regression due to the combination of the first two variable factors. 4. Residual gastric cardia cancer. Cancer of the residual gastric capsule after distal partial gastrectomy has been increasingly reported. Its incidence rate is 0.55%~8.9%, among which those occurring in the cardia department account for 16.4%~58.5% of all. Residual gastric cardia cancer is 1.5%~2.7% among cardia cancers.