Proximal gastrectomy was introduced as a function-preserving operation for early gastric cancer (EGC). The aim of this study was to investigate long-term outcomes after this procedure. Between 1993 and 2005, patients with suspected EGC in the upper third of the stomach underwent proximal gastrectomy. The long-term oncological and surgical outcomes were assessed. Of 128 patients thought to have EGC, 14 had advanced disease. Nodal involvement was seen in 13 patients (10.2 per cent). Postoperative complications developed in 20 (15.6 per cent). Anastomotic stricture was the most frequent complication, occurring in 13 patients (10.2 per cent). There were no postoperative deaths. During follow-up, nine patients (7.0 per cent) were hospitalized owing to bowel obstruction. Eight (6.3 per cent) developed a second primary gastric carcinoma. The overall 5-year survival rate was 90.5 per cent. Proximal gastrectomy is well tolerated, with excellent outcomes in patients with suspected EGC. It is recommended as a standard procedure for the treatment of EGC in the upper third of the stomach. Copyright (c) 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.