Background and Aims Gastric cancer is a common malignant tumor of the digestive tract in China, and surgery remains a crucial method for its treatment. Proximal gastrectomy (PG) is an option for early upper gastric cancer, including adenocarcinoma of the esophagogastric junction. Numerous studies have confirmed the oncological safety and functional benefits of PG in the treatment of early upper gastric cancer, and its overall survival rate is equivalent to that of total gastrectomy with improvements in maintaining physiological function and quality of life. However, due to the problems such as reliable prevention of reflux, anastomotic stenosis, and technical difficulties, there is still no widely used ideal anastomotic method after PG. Therefore, optimizing digestive tract reconstruction after PG is necessary. Here, the authors report the feasibility and preliminary efficacy analysis of modified double-tract reconstruction (DTR) applied in the reconstruction of the digestive tract after PG to evaluate the clinical application value of this new anastomotic approach.Methods The clinicopathologic data of 46 patients with adenocarcinoma of the esophagogastric junction or upper gastric tumors who underwent laparoscopic PG in two hospitals from June 2019 to December 2022 were retrospectively collected (35 cases in Heji Hospital affiliated to Changzhi Medical College and 11 cases in Heping Hospital affiliated to Changzhi Medical College). Among them, 21 cases underwent modified DTR (observation group), and 25 cases underwent traditional jejunal interposition DTR (control group). Surgical safety and efficacy were compared between the two groups.Results There were no statistically significant differences in baseline data between the two groups (all P>0.05). There were no statistically significant differences between the two groups in terms of total operative time, intraoperative blood loss, number of lymph nodes dissected, time to abdominal drainage tube removal, length of postoperative hospital stays, and total hospitalization costs (all P>0.05). In the observation group compared with the control group, the time to first postoperative anal gas passage (58 h vs. 72 h, P=0.035) and postoperative diet resumption (6 d vs. 8 d, P<0.001) were shorter, but the time for digestive tract reconstruction was longer (65.29 min vs. 58.95 min, P=0.005). There were no significant differences between the two groups in postoperative pulmonary infection, pleural effusion, wound infection, intestinal obstruction, or Clavien-Dindo classification of postoperative complications (all P>0.05). There were no occurrences of anastomotic leakage or stenosis in either group. The incidence of reflux esophagitis in the observation group was 4.8% (1/21), compared to 8.0% (2/25) in the control group, with no statistically significant difference (χ²=0.196, P=0.658), and all cases were graded as grade A according to the Los Angeles classification. At 6 months after operation, the albumin level in the control group was lower than that in the observation group (37.1 g/L vs. 42.7 g/L, P=0.001), while there were no significant differences in other nutritional indicators (body mass index, hemoglobin, total protein) between the two groups (all P>0.05). Gastrointestinal imaging at 6 months after operation showed decreased peristalsis in 4 cases (19%) of the observation group and 9 cases (36%) of the control group, with no statistically significant difference (χ²=1.358, P=0.327).Conclusion Modified DTR after PG is safe and feasible. Compared with jejunal interposition DTR, the former has a longer digestive tract reconstruction time but faster postoperative recovery of gastrointestinal function, better short-term nutritional status, and does not increase the risk of postoperative complications.