Appetite-preserving gastrectomy APG is a novel function-preserving surgical approach recently proposed in gastric cancer surgery. Its core principle involves the precise preservation of the fundus and fornix—the primary secretion area of ghrelin—to ensure oncological radicality while maintaining postoperative appetite thereby improving nutritional status and quality of life. This article provides a systematic review of the definition theoretical foundation clinical efficacy current controversies and future directions of APG. Current evidence suggests that APG demonstrates favorable perioperative safety in patients with esophagogastric junction cancer and offers advantages in short - term appetite preservation weight change and nutritional indicators. However controversies remain regarding its long-term oncological safety certainty of functional benefits and patient selection criteria. There is an urgent need for large-scale multi-center randomized controlled trials to provide higher-level evidence. Future development of APG should focus on precise patient selection technical standardization application of minimally invasive platforms and multidisciplinary integrated management to promote its advancement toward a safer more effective and individualized approach.