Objective To explore the application of nutritional status assessment in chemotherapy tolerance of patients after total gastrectomy. Method 154 gastric cancer patients who received radical total Gastrectomy and postoperative chemotherapy from March 2018 to February 2022 in Beijing Luhe Hospital Capital Medical University were included as the study subjects. According to whether the patients stopped chemotherapy within 6 months after surgery they were divided into tolerance group n = 122 and intolerance group n = 32 . Kaplan Meier curve was used to analyze the relationship between the stratification of chemotherapy duration and the survival rate of patients after total gastrectomy Single factor logistic regression was used to analyze the influencing factors of chemotherapy tolerance in patients after total gastrectomy and Receiver operating characteristic was drawn to analyze the predictive value of related factors. Result Kaplan Meier survival curve analysis showed that chemotherapy tolerance of patients after total gastrectomy was related to overall survival rate Log Rank Mantel Cox = 11. 017 P = 0. 001 . Age basic diseases nutritional risk screening 2002 NRS 2002 prognostic nutritional index PNI carcinoembryonic antigen CEA albumin ALB and hemoglobin Hb of the patients in the two groups. The variables in univariate analysis P<0. 05 were included in multivariate Logistic regression model and the results showed that age OR= 6. 150 PNI OR = 3. 263 Hb OR = 1. 090 and ALB OR = 1. 342 were the independent risk factors of chemotherapy tolerance of patients after total gastrectomy P<0. 05 . The ROC curve shows that the area under the curve AUC of age is 0. 694 95%CI = 0. 615-0. 766 that of PNI is 0. 774 95%CI = 0. 700-0. 838 that of Hb is 0. 893 95%CI = 0. 833-0. 937 and that of ALB is 0. 814 95% CI = 0. 743 - 0. 872 . Conclusion Older age low prognostic nutritional index and low levels of hemoglobin and albumin are risk factors for chemotherapy tolerance in patients after total gastrectomy among which hemoglobin and albumin levels have significant predictive efficacy on chemotherapy tolerance of patients after total gastrectomy and need to be used as predictive indicators for postoperative chemotherapy tolerance of patients with gastric cancer.