AbstractFrom October 1967 to August 1976 posterior invagination esophagogastrostomy in 1 stage without positional change was performed on 84 patients. Since 1971 this method has been extended to include 32 cases of cancer of the upper and middle thirds of the thoracic esophagus. The anastomosis was constructed in the neck in 27 patients, and in the thoracic cavity in 5 patients (1 supra‐aortic, 2 at the level of the aortic arch, and 2 at the level of the inferior margin of the aortic arch). There were no instances of postoperative anastomotic leakage, hemothorax, chylothorax or pyothorax. Six of these patients (18.8%) died of circulatory insufficiency or pulmonary complications within 1 month of operation. Postoperative esophageal stenosis occurred at the site of anastomosis in 4 patients and was relieved by bougienage dilatation or operation under local anesthesia. Of the 32 patients with lesions in the upper and middle thoracic esophagus, 17 survived for 6 months after operation, 6 have lived for at least 3 years, and 4 are still alive after 4 years. Postoperative examinations of autonomic nervous system and cardiopulmonary functions revealed no abnormalities. In the early postoperative period, lipid and Vitamin B12absorption was markedly disturbed but returned to normal levels by the time of the follow‐up studies.