Background: The aim of the present study was to compare the difference between double tract reconstruction and esophagogastrostomy after proximal gastrectomy.Methods: Patients who underwent radical proximal gastrectomy with esophagogastrostomy or double tract reconstruction from December 2014 to May 2019 were included in this study.Results: Sixty-four patients were included in this study and divided into two groups according to reconstruction method. The two groups were well balanced in terms of length of postoperative hospital stay, blood loss volume, postoperative complications, and 5-year disease-free survival (DFS). The operation duration in the double tract reconstruction group was longer than that in the esophagogastrostomy group (240 min vs 195 min, P = 0.001). The rates of postoperative reflux esophagitis in the double tract reconstruction group and esophagogastrostomy group were 8.0% and 30.8%, respectively (P = 0.032). The multivariable logistic regression analysis showed that the reconstruction method was the only independent risk factor for reflux esophagitis (P = 0.004). Patients in the double tract reconstruction group had better global health status (P < 0.001) and emotional functioning (P < 0.001), and complained less about nausea and vomiting (P < 0.001), pain (P = 0.039), insomnia (P = 0.003), and appetite loss (P < 0.001) based on the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire. Regarding the EORTC QLQ-STO22 questionnaire, patients in the double tract reconstruction group complained less about dysphagia (P = 0.030), pain (P = 0.008), reflux (P < 0.001), eating (P < 0.001), anxiety (P < 0.001), dry mouth (P = 0.007), and taste (P = 0.001). The multiple linear regression analysis showed that reconstruction method, postoperative complications, reflux esophagitis, and operation duration had a linear relationship with the global health status score.Conclusions: Double tract reconstruction after proximal gastrectomy was comparable with esophagogastrostomy in terms of perioperative safety and 5-year DFS. Double tract reconstruction could better prevent reflux esophagitis and improve quality of life. There was a linear relationship between global health status score and reconstruction method, reflux esophagitis, postoperative complications, and operation duration.