Background <p>The aim of this study was to compare the effects of accommodated jejunal interposition double tract reconstruction (aji-DTR) and Roux-en-Y reconstruction after laparoscopic-assisted total gastrectomy on intraoperative and postoperative indicators in advanced gastric cancer (AGC) patients.</p> Methods <p>A retrospective analysis was performed on 80 AGC patients, including 43 with aji-ATR and 37 with Roux-en-Y reconstruction. Propensity score matching was performed between the two groups.</p> <p>The primary outcome measures included operative time, intraoperative blood loss, postoperative complications, postoperative hospital stay, total hospitalization costs, and survival rate. The secondary outcome measures were postoperative nutritional status, recovery of digestive function, and postoperative gastrointestinal·symptoms.</p> Results <p>There were 24 pairs of patients after matching. There were no significant differences in the operative time, intraoperative blood loss, time of first flatus, time of first defecation, time of liquid diet, time of semi-liquid diet, postoperative complications, postoperative hospital stays, and total hospitalization costs (all <i>P</i> &gt; 0.05). Interestingly, Roux stasis syndrome was significantly more frequent in Roux-en-Y group than aji-DTR group [6 (25.0%) vs 1 (4.2%), <i>P</i> = 0.045]. While no significant difference was observed in survival rates, reflux esophagitis, dumping syndrome and nutritional parameter including hemoglobin, albumin, and prognostic nutritional index (all <i>P</i> &gt; 0.05).</p> Conclusions <p>Compared with Roux-en-Y reconstruction, aji-DTR had similar surgical parameters, postoperative digestive function recovery, nutritional parameters, and survival rate, but showed an advantage in reducing Roux stasis syndrome. Therefore, aji-DTR after laparoscopic assisted total gastrectomy may be a safe and feasible alternative for AGC patients.</p>