Objective: To investigate the application value of transposition of a transverse colon segment for gastric replacement after total gastrectomy in treatment of gastric carcinoma. Methods: One hundred and ninety-three gastric cancer patients requiring total gastrectomy were randomly divided into control group and observation group. Patients in control group underwent the conventional Schlatter’s or Roux-en-Y esophagojejunostomy for digestive tract reconstruction, while those in observation group received gastric reservoir construction of transverse colon transposition after total gastrectomy. The alterations in T-lymphocyte subsets, IL-2 level, and mediators of acute inflammation before operation and at postoperative day (POD) 1 and 9, as well as the mortality, incidence of postoperative complications and length of hospital stay between the two groups were compared. Results: There were no significant differences between the two groups in all parameters before operation and at POD 1 (all P>0.05). At POD 9, the percentage of CD4+ T cells, ratio of CD4+ to CD8+ T cells and IL-2 level in observation group were significantly increased, but the percentage of CD8+ T cells and levels of IL-6 and C-reactive protein (CRP) were significantly decreased compared with control group (all P>0.05). No differences were noted in postoperative death and incidence of postoperative complications between the two groups (both P>0.05), however, the average length of hospital stay in observation group was significantly shorter than that in control group (P<0.05). Conclusion: Transverse colon interposition for gastric reservoir is a safe procedure for reconstruction of alimentary tract, which is beneficial for improving the postoperative immune function in gastric cancer patients.