Proximal gastrectomy offers survival rates similar to total gastrectomy after neoadjuvant therapy for Siewert Type II/III gastric adenocarcinoma.

• No significant differences in overall survival (p = 0.54) or progression-free survival (p = 0.86) were found between the two approaches.
• The study included a balanced cohort of 518 patients from three centers, reinforcing the findings across different cancer stages.

Surgeons can consider proximal gastrectomy as a viable option without compromising patient outcomes.

• Higher metastatic rates were noted at distal nodal stations in stage III patients, indicating the need for careful patient selection.