A 73-year-old man was diagnosed with upper thoracic esophageal squamous cell carcinoma based on endoscopic findings at another clinic. It showed B2 vessels: abnormal vessels with poor loop formation and B3 vessels: markedly dilated abnormal vessels which suggest submucosal invasion based on Japan Esophageal Society classification. He had undergone pylorus-preserving PD (PPPD) with Child’s reconstruction for a mixed-type intraductal papillary mucinous neoplasm 3 years earlier at the previous hospital and was referred to the department of surgery of the same hospital. However, although the surgeons there recommended definitive CRT due to difficulty in performing subtotal esophagectomy after PD, the desired to undergo the surgical treatment and was thus referred to our department. The clinical diagnosis was upper thoracic esophageal squamous cell carcinoma, cT1bN0M0, cStage I, UICC 8th []. The planned surgical procedure was robot-assisted thoracoscopic subtotal esophagectomy and lymph node dissection in three fields (neck, thorax, and abdomen) with the reconstruction of the free jejunal interposition. The surgery was performed as planned. For prone thoracic manipulation, robot-assisted thoracic lymph node dissection and thoracic esophageal resection were performed at the level of the aortic arch. The thoracic duct and bilateral recurrent nerves were preserved using a nerve integrity monitor (NIM, Medtronic, Tokyo, Japan). Subsequently, cervical and abdominal manipulations were performed in the supine position. For neck manipulation, bilateral recurrent nerve sparing, lymph node dissection, and cervical esophagus resection were performed. During abdominal manipulation with a median incision, there were no significant peritoneal adhesions. The lesser curvature of the remnant stomach was dissected and the left gastric artery was resected. Standard regional abdominal lymph node dissection for thoracic esophageal cancer was performed, while preserving the left gastroepiploic, short gastric, and posterior gastric arteries. The stomach was cut using an automated suture device just below the esophagogastric junction and the specimen was removed, preserving almost the entire remnant stomach. After observing the vessels of the jejunum in detail, the main trunks of the first and second jejunal arteries were used for the reconstruction of the previous PPPD. Therefore, a free jejunal flap with the margins of the second and third jejunal arteries was used for the reconstruction. Subcutaneous reconstruction was performed, and the right internal thoracic artery and vein were used for vascular anastomosis. The anastomosis of the cervical esophagus and free jejunum flap was performed using an automated anastomosis device for end-to-side anastomosis. The anastomosis of the free jejunum flap and remnant stomach was performed using an automated suture device. Finally, an evaluation of the circulation using intravenous indocyanine green (ICG) revealed that the circulation of the reconstructed organ was preserved. On postoperative day 1, no recurrent nerve paralysis was shown by the laryngeal fiber. The patient was discharged from the intensive care unit on postoperative day 6 and started oral intake on postoperative day 14. The patient had no postoperative complications related to the reconstruction and was transferred to another hospital on postoperative day 21 for rehabilitation. The lymph node metastasis was observed in 106recR in the postoperative pathological findings. The pathological result indicated esophageal squamous cell carcinoma, pT1bN1M0, pStageIIB, UICC 8th [].