Background: The incidence of upper-third early gastric cancer (EGC) has been increasing in East Asia. Although total gastrectomy (TG) has been a standard treatment for upper-third EGC, proximal gastrectomy (PG) or distal gastrectomy (DG) can be indicated for some selected patients. Theoretically, the more we preserve stomach volume, the better postoperative quality of life will be. However, this issue is not fully investigated. The aim of this study was to clarify the most suitable procedure for upper-third EGC. Methods: This study included 187 patients who underwent TG (n = 20), PG (n = 138), or DG (n = 29) for cT1N0 upper-third gastric cancer between 2009 and August 2017. Surgical outcomes, including bodyweight change one year after the surgery, were retrospectively compared among surgical procedures. DG was generally selected if the distance between the esophagogastric junction (EGJ) and proximal margin of the tumor was more than 20 mm. PG was chosen if at least the distal half of the stomach could be preserved. Otherwise, TG was performed. Results: Background characteristics and proportion of laparoscopic approach were not different among the groups. The duration of surgery was not significantly different, but intraoperative blood losswas significantly less in DG than PG (19 vs. 39 g, p = 0.02). The incidence of Clavien-Dindo classification grade IIIa or more anastomosis-related complications was less frequent in DG (3.4%) than in PG (15.9%, p = 0.13) or TG (10%, p = 0.56), although the differences were not statistically significant. Albumin and hemoglobin levels one year after surgery were not significantly different among the groups. Bodyweight loss one year after surgery was less in DG (11.1%) than in PG (14.6%, p = 0.03) or TG (16.6%, p< 0.01). Conclusions: DG was a safe procedure with less bodyweight loss, and thus preservation of the EGJ should be considered for all patients with tumors at least 2 cm apart from the EGJ. If the distance between EGJ and tumor is less than 2 cm, PG or TG will be indicated. However, surgical outcomes between PG and TG in this study were not different, and therefore, further investigations including long term quality of life are necessary.