Background and Aims: Laparoscopic radical gastrectomy has become the first choice for surgical treatment of gastric cancer. The surgical procedure mainly comprises radical resection of the tumor and digestive tract reconstruction. Digestive tract reconstruction is a difficult technique during the operation, and especially, the totally laparoscopic esophagojejunostomy is the most difficult procedure to perform, which greatly restricts the clinical development of totally laparoscopic radical total gastrectomy. The π-shaped esophagojejunostomy is a linear anastomosis technique based on a linear cutting closure device, which is reported to simplify the procedure and shorten the operative time. Therefore, this study was conducted to evaluate the application value of π-shaped esophagojejunostomy in totally laparoscopic radical total gastrectomy.  
Methods: The clinical data of 78 patients with gastric cancer treated in the Department of Gastrointestinal Surgery of Wuhu Second People's Hospital between January 2016 and January 2020 were retrospectively analyzed. All patients underwent total laparoscopic gastrectomy with D2 lymphadenectomy. Of the patients, 40 cases underwent π-shaped esophagojejunostomy (observation group) and 38 cases underwent traditional functional end-to-end esophagojejunostomy (control group) for digestive tract reconstruction. The main intra- and postoperative variables were compared between the two groups of patients. 
Results: Total gastrectomy, lymphadenectomy and digestive tract reconstruction were uneventfully completed in all patients under totally laparoscopic surgery, none required open conversion and all had a negative esophageal margin. In observation group compared with control group, the total operative time and the operative time for esophagojejunostomy were significantly shortened, and the intraoperative blood loss was significantly decreased (217.4 min vs. 237.9 min; 22.6 min vs. 34.8 min; 64.4 mL vs. 99.2 mL, all P<0.05); the time to first ambulation and the time to first flatus passage after the operation were all significantly shortened (1.5 d vs. 2.3 d; 2.6 d vs. 2.9 d, both P<0.05). Postoperative complications occurred in 3 patients in observation group and 2 patients in control group, and the incidence of postoperative complications had no significant difference between the two groups (P=0.687). There were no significant differences in terms of the length of postoperative hospital stay and the number of resected lymph nodes between the two groups (both P>0.05). Postoperative follow-up was conducted for 3 to 12 months, and the anastomotic stoma was patent in all patients. 
Conclusion: The application of π-shaped esophagojejunostomy is safe and feasible in totally laparoscopic radical total gastrectomy. Compared with the traditional functional end-to-end esophagojejunostomy, it has the advantages of shorter operative time and esophagojejunostomy time, and faster postoperative recovery. Its short-term efficacy is also satisfactory.