| Objective To investigate the clinical efficacy of three-dimensional (3D) high definition (HD) total laparoscopic gastrectomy for patients with gastric stump cancer after subtotal gastrectomy of benign gastric diseases. Methods From May 2015 to June 2018, 19 patients with gastric stump cancer received 3D HD laparoscopic gastrectomy in the Second Affiliated Hospital of Dalian Medical University. All patients had subtotal gastrectomy for benign gastric diseases. All patients were diagnosed with gastric cancer by gastroscopy and pathological biopsy before admission. A retrospective cross-sectional study was conducted. Postoperative recovery, pathological condition and hospitalization expenses of the patients were analyzed statistically. Results (1) Surgery: Among the 19 patients with gastric stump cancer, 18 underwent 3D HD laparoscopic radical gastrectomy, 1 underwent 3D HD laparoscopic palliative gastrectomy. The operation time was (223.63±53.47) min, the amount of bleeding during operation was (136.32±82.95) mL, and the number of lymph nodes dissected was (26.05±6.84). (2) Postoperative condition: postoperative ambulation time was (1.39±0.46) d, postoperative first flatulence time was (2.08±0.92) d and postoperative feeding time was (4.45±2.39) d. The time of intraperitoneal drainage after operation was (9.95±5.28) d, and the length of postoperative hospitalization was (13.74±9.69) d. The total cost was (80271.69±22536.91) Yuan. Postoperative anastomotic leakage occurred in 1 case, duodenal stump leakage in 1 case, incision infection in 1 case, lung infection in 2 cases, and no perioperative death. (3) Follow-up: 19 patients who underwent 3D HD totally laparoscopic gastrectomy were followed up for 3-40 months with a median of 17 months. During the follow-up, 7 patients died and 12 survived. Conclusion 3D total laparoscopic gastrectomy is safe and effective for gastric stump cancer after subtotal gastrectomy for benign gastric diseases.