Abstract:Background and Aims The incidence of adenocarcinoma of the esophagogastric junction (AEG) has increased steadily in recent years, and laparoscopic total gastrectomy has become an important treatment option. Circular-stapled esophagojejunostomy may provide better proximal margin control for high tumors, but remains technically challenging under a totally laparoscopic approach. Comparative evidence between totally laparoscopic total gastrectomy (TLTG) and laparoscopy-assisted total gastrectomy (LATG) using circular-stapled esophagojejunostomy is still limited. This study aimed to compare the perioperative safety and short-term outcomes of these two procedures using propensity score matching (PSM).Methods Clinical data of patients with AEG who underwent laparoscopic total gastrectomy with Roux-en-Y circular-stapled esophagojejunostomy at Yancheng First People's Hospital and Hanzhong Central Hospital between January 2023 and June 2025 were retrospectively analyzed. Patients were divided into the TLTG group and LATG group according to surgical approach. Baseline characteristics, operative outcomes, postoperative recovery, and complications were compared. A 1∶2 PSM analysis was performed to minimize baseline bias.Results A total of 436 patients were enrolled, including 98 in the TLTG group and 338 in the LATG group. After PSM, 80 patients in the TLTG group and 160 patients in the LATG group were successfully matched with balanced baseline characteristics. Operative time and anastomosis time were significantly longer in the TLTG group (both P<0.001). However, intraoperative blood loss, number of retrieved lymph nodes, and hospitalization cost were comparable between the two groups (all P>0.05). Compared with the LATG group, the TLTG group showed lower postoperative 24-h pain scores, earlier first flatus, and shorter postoperative hospital stay (all P<0.001). No significant differences were observed in overall postoperative complications or Clavien-Dindo grade Ⅰ-Ⅲ complications between groups (all P>0.05). No grade Ⅳ complications or perioperative deaths occurred.Conclusion Circular-stapled esophagojejunostomy after TLTG is as safe as that after LATG in the perioperative setting and offers significant advantages in postoperative pain relief, gastrointestinal recovery, and hospital stay reduction. With the assistance of laparoscopic purse-string devices and multifunctional sealing caps, intracorporeal circular anastomosis can be performed safely and reliably, particularly in patients with Siewert type Ⅱ tumors requiring adequate proximal esophageal margins.