Background <p>Globally, totally laparoscopic total gastrectomy is increasingly being accepted by surgeons for the treatment of gastric cancer. Overlap anastomosis and π-shaped anastomosis are the two most commonly used anastomosis methods in total laparoscopic surgery; however, their safety and suitability for the population are still unclear.</p> Methods <p>A total of 162 consecutive patients with gastric cancer who underwent total laparoscopic total gastrectomy with overlap or π-shaped anastomosis were retrospectively analyzed. The intraoperative conditions and postoperative complications were compared.</p> Results <p>A significant difference in the tumor location was found between the two groups&#xa0;(p &lt; 0.05). No significant difference was found in the operation time, intraoperative blood loss, and postoperative hospital stay between the two anastomosis methods (p &gt; 0.05); however, the π-shaped anastomosis group had more postoperative anastomotic leakage (<i>p</i> &lt; 0.05).</p> Conclusions <p>Overlap anastomosis is recommended as the preferred anastomosis for totally laparoscopic total gastrectomy, and π-shaped anastomosis can be applied to non-gastroesophageal junction cancer with lower tumor location.</p>