Background and Aims In recent years, function-preserving proximal gastrectomy with reconstruction has become an important approach for the treatment of early gastric cancer. However, there is no standardized surgical technique, and the short- and long-term outcomes of various new procedures remain unclear. This study was performed to evaluate the safety and short-term efficacy of laparoscopic proximal gastrectomy plus esophagogastrostomy with single-flap technique for early gastric cancer.Methods The clinical data and follow-up records of 7 patients who underwent laparoscopic proximal gastrectomy with single-flap esophagogastrostomy in the First Affiliated Hospital of Soochow University between December 2021 and December 2022 were retrospectively analyzed. Perioperative safety, postoperative reflux, anastomotic stricture at 6 months, and related nutritional parameters were assessed. The nutrition-related indicators of this group of patients were compared with those of 11 patients who underwent total gastrectomy with Roux-en-Y anastomosis for early gastric cancer during the same period.Results All 7 patients successfully underwent laparoscopic proximal gastrectomy with single-flap esophagogastrostomy. The average operative time was (212.9±20.6) min, with anastomosis taking (54.7±10.5) min; the mean intraoperative blood loss was (28.6±9.0) mL. No Clavien-Dindo grade Ⅲ or higher complications were observed during hospitalization. None of the patients experienced significant reflux symptoms, although 1 patient developed anastomotic stricture 3 months after operation. There were no statistically significant differences in hemoglobin concentration, albumin level, prealbumin level, total protein concentration, and lymphocyte count between preoperative and 6-month postoperative measurements (all P>0.05). Compared to patients who underwent total gastrectomy with Roux-en-Y anastomosis, those who had the proximal gastrectomy with single-flap esophagogastrostomy showed a lower percentage decrease in body weight, skeletal muscle area at the third lumbar vertebra (L3), visceral fat area at L3, and hemoglobin concentration at 1 year after operation (all P<0.05).Conclusion Laparoscopic proximal gastrectomy with single-flap esophagogastrostomy is a safe and feasible surgical option for early gastric cancer, offering effective anti-reflux outcomes while minimizing the risk of anastomotic stricture. This procedure has a lower impact on postoperative nutritional status compared to total gastrectomy.