The patient was a 69-year-old man admitted for nearly 2 months of progressive dysphagia with histories of intestinal polyps and intraductal papillary mucinous neoplasm (IPMN) of the pancreas who underwent endoscopic surgery intestinal polypectomy and laparoscopic PPPD, respectively 9 months ago. Endoscopy showed a tumour in the middle, and lower thoracic oesophagus (29 to 35 cm from the incisors), and a biopsy revealed a squamous cell carcinoma. Further contrast-enhanced computed tomography (CT) and gastrointestinal contrast showed that the tumour was above the inferior pulmonary vein, without extraesophageal invasion. Previous gastrointestinal anastomosis of PPPD was illustrated by gastrointestinal contrast. No evidence of lymphadenopathy or distant metastasis was evaluated by fluorodeoxyglucose-positron emission tomography (FDG-PET). Therefore, the tumor was clinically staged as cT3N0M0 and was considered for primary resection (Ivor-Lewis oesophagectomy). Abdominal exploration was performed by median laparotomy, moderate intra-abdominal adhesion around the residual pancreas and near anastomosis, the remaining jejunum and ileum also had adhesions, and the proximal right gastroepiploic artery and right gastric artery were both severed in the previous operation. Fortunately, the vessel arch of the greater curvature was still intact, and the blood supply to the remnant stomach was the left gastroepiploic artery, left gastric artery, posterior gastric artery and short gastric vessels (as shown in Fig. A). Because of colonic polyps, short jejunum (due to previous operation and digestive tract reconstruction) and intestinal adhesion, we realised that they could not be used as an oesophageal substitute except for remnant stomach. The remnant stomach was then mobilised by excising the cardia and lesser curvature stomach, including the left gastric artery, removing the duodenal jejunal anastomosis and dividing the gastrohepatic omentum. After complete mobilisation of the stomach, a 3-cm-wide gastric conduit was created using closer linear cutting (Ethicon ECHELON + Stapler PSEE60A). Next, a new side-to-side anastomosis was reconstructed between the gastric fundus and jejunum, and no feeding jejunostomy was performed. The left gastroepiploic artery, posterior gastric artery and short gastric vessels were reserved in the original location to ensure the blood supply of the thoracic stomach. Hence, the left gastroepiploic artery became the only source of blood supply to the gastric conduit. Thoracotomy was performed via a posterolateral incision at the right fifth intercostal. The oesophagus was dissected from the oesophagogastric junction to the level of the azygos vein arch. Complete resection of the oesophageal tumour was achieved. Lymph node dissection was routinely performed at the time of resection, which include Stations 2R, 4R, 4 L, 7, 8U, 8 M, 8Lo, 9R, 10R, 15, 16 and 17. The gastric conduit was passed reversely through the hiatus to the oesophageal bed and layered end-to-side manual intrathoracic anastomosis with the oesophagus. Microscopic examination revealed a moderately differentiated squamous cell carcinoma without evidence of lymph node metastasis at any station (pT3N0M0 G2, stage IIB) and a negative surgical margin (R0). After surgery, the patient received gastrointestinal decompression and 5 days total parenteral nutrition support. He was started on a liquid diet on postoperative Day 6 and a soft blended diet on Day 10. Thoracic stomach emptying was delayed, but no anastomotic stenosis or thoracic stomach fistula was documented by upper gastrointestinal contrast on a postoperative Day 5. After liquid diet intake for 3 days, symptoms from delayed gastric emptying largely disappeared, and the patient was discharged from the hospital on a postoperative Day 12 with no complications. Follow-up at the third month after the operation showed that the patient was satisfied with his life and had no complications. No thoracic stomach emptying was delayed, anastomotic stenosis, thoracic stomach dilatation or conduit redundancy was observed at the one-year-follow-up, and no gastrointestinal dysfunction or anemia was observed.