The philosophy behind this operation is not only to remove the esophagus and its tumor, but also to remove as much of the lymph node tissue surrounding the esophagus as possible. Only in this manner can one remove all potential regional sites of tumor spread to maximize the chances of cure. To do so, the surgeon must operate in the chest and abdomen, and reconstruct the esophagus using part of the stomach that is constructed into a narrow tube. This gastric tube is then brought up into the neck and reconnected to healthy esophagus to restore the alimentary tract. The patient therefore requires an incision in the neck, chest and abdomen for the complete operation.