From 1978 through 1990, 90 total gastrectomies with esophagojejunostomy via thoracotomy were performed for the treatment of cancer of the cardia or fundus of the stomach in our hospital. Eighty-five patients were in TNM-stage III and five in stage IV. The 30-day postresectional mortality was 1.1%, and the 5-year survival rate was 13.8%. 14CO2 breathing test and clinical evaluation of 34 postoperative patients (not included in the 90 patients) showed that total gastrectomy may decrease the incidence of positive residual cancer along the incision lines, and may help to avoid small stomach syndrome. There was no statistical difference in postoperative fat absorption between patients treated by ordinary proximal subtotal gastrectomy and those receiving total gastrectomy via thoracotomy.