The most common indication for an esophagogastrectomy is esophageal cancer. Other indications include Barrett's esophagus with high-grade dysplasia, non-dilatable esophageal stricture, and irreparable esophageal rupture. There are multiple surgical techniques that present specific advantages and disadvantages. However, the postoperative management and complications associated with any esophagogastrectomy are very similar. The two most common methods for removing the esophagus are the transhiatal esophagectomy (THE), which consists of incisions on the neck and abdomen, and the Ivor Lewis esophagectomy (ILE) which consists of a laparotomy and a right lateral thoracotomy. Both approaches allow resection of the esophagus and mobilization of the gastric conduit. The stomach is the typical conduit used for the neo-esophagus; however, the colon and jejunum may also be used if the stomach is not ideal. Preoperative gastrostomy tubes should be avoided since they can damage the stomach and prohibit its use as the preferred replacement conduit.

The esophagus must be carefully dissected away from other mediastinal structures. Esophageal blood supply originates from small branches off the aorta. Vasoconstriction often controls these small vessels when bluntly transected; otherwise, simple electrocautery suffices. To mobilize the stomach as a conduit, the short gastric, left gastroepiploic, and left gastric arteries are sacrificed. The stomach blood supply is maintained by the carefully preserved right gastroepiploic and right gastric arteries. The stomach is fashioned into a gastric conduit by stapling along the lesser curve of the stomach to create a tubularized gastric conduit. Oversewing the gastric staple line is theorized to reduce gastric conduit leak. Since the gastric conduit is denervated, a gastric emptying procedure should be considered. Either a pyloromyotomy or pylorplasty is most commonly done. Botox injection of the pylorus has also been used to facilitate conduit emptying during early healing. The duodenum is often mobilized with a Kocher maneuver to provide additional conduit length and reduce tension. The gastric conduit is passed through the esophageal hiatus into the native esophageal bed in the posterior mediastinum. Alternate routes for the conduit include the chest hilum and subxyphoid pathways. An esophagogastric anastamosis is performed in the chest for ILE; in the neck for THE. Hand sewn, stapled, and combination anastomoses have been described.