The 30 years experience of surgical treatment of the proximal gastric cancer type II and III by Siewert classification in 681 patients was analyzed. 448 gastrectomies and 233 gastrectomies with proximal esophagus resection were performed. Gastrectomy with esophagus resection led to more complications (34.8±3.1%; p<0.001) and lethal out±comes (21.5±2.7%), then standart gastrectomy (16.5±1.8% and 7.6±1.3%). The dehiscence of the esophagointestinal anastomosis was registered in 5.6±1.6% after the gastrectomy with esophagus resection and in 0.2±0.2% after the transperitoneal gastrectomy (p<0.001). The loop method by Schlattler proved to be the optimal reconstructive technique. The Roux-en-Y anastomosis was preferable by the insufficient length of the mesentery. The risk factors of the esophagointestinal anastomosis insufficiency were: cancer stage (p<0.001), local invasion of the neighbouring organs (p<0.05), combined surgery and esophagus invasion (p<0.001), male gender (p<0.001) and lack of the surgical skills for gastrectomy (p<0.02).