It is well known that esophagectomy is the main surgical procedure for the treatment of esophagus-related diseases. Esophageal reconstruction after esophagectomy was first proposed in 1942. Today, there are the familiar Sweet, Ivor-Lewis, and McKeown procedures, in which the most common esophageal replacement organ is gastric tissue. With better understanding of the disease and improved surgical techniques, complications associated with esophageal resection remain a major concern for surgeons. Although different centers or units have their own knowledge, understanding, and ways to prevent and treat related complications, we still shoulder a lot of responsibility for this unavoidable problem. Anastomosis-related complications include anastomotic fistulae and stenosis, and the occurrence of anastomotic fistulae is probably the last thing a surgeon wants to see, especially when it occurs in the thoracic cavity along with infections that lead to respiratory abnormalities and hemodynamic instability, which are often fatal to the patient. Although surgical anastomosis techniques include manual full-layer and layered suture; anastomotic mechanical anastomosis; or manual + anastomotic anastomosis, the occurrence of anastomotic fistula involves a variety of factors in addition to localization. But the occurrence of anastomotic fistula involves many factors other than localization. If you are really able to “flexibly” use different surgical instruments, fully grasp the anatomy and physiology of the esophagus, as well as the surgical “technology” operation of the “knowledge”, we believe that fatal anastomotic fistulas can be avoided. It is believed that the occurrence of fatal anastomotic fistula can be avoided. After all, each patient has different clinical characteristics and esophageal tumors, and no single surgical procedure can be applied to all patients. Therefore, an experienced surgeon should be able to select an appropriate and individualized treatment to achieve a successful outcome. Another complication associated with surgery is celiac disease. Although the incidence of this complication is only 2.7-3.8%, celiac disease does not heal spontaneously once the thoracic duct is damaged, unlike fibrinogen in the blood. Moreover, it is rich in lymphocytes, immunoglobulins, and a variety of biologically relevant enzymes, the loss of which would pose a great threat to the patient’s life and health. Thoracic ducts have a fixed alignment, but clinical data show that only 55% of patients have a fixed position of the thoracic duct, while the other 45% have a variable position. Although gentle movements and good dissection can prevent chest tube damage during surgery, there is still a chance of damage. If celiac disease is suspected in clinical practice, laboratory and imaging tests should be used to clarify the diagnosis as soon as possible, and corresponding therapeutic programs should be adopted to promote the patient’s recovery. Functional complications of the reconstructed esophagus, such as gastric emptying disorder, dumping syndrome, and reflux, will greatly affect the patient’s long-term quality of life. After the stomach is lifted from the abdominal cavity to the thoracic cavity, due to changes in multiple factors such as anatomy, physiology, shape, and size, it can cause different degrees of the above symptoms, while delayed emptying and reflux are the most common. Since surgical treatment of esophageal neoplastic diseases will inevitably change the anatomical structure and physiological function, and destroy the blood supply and innervation of the stomach, the only way to prevent and treat these symptoms is through surgical methods such as the fabrication of tubular stomach, posterior mediastinal pathway, reduction of resection of gastric sinus tissues on the side of the lesser curvature, and improvement of anastomotic position (reduction of anastomoses under the arch of the aorta), as well as supplemented with medical drug treatments, change of dietary habits (small meals and more frequent meals), and avoiding lying down immediately after meals and exercise. The incidence of these complications can be prevented and minimized with the use of medications, dietary changes (smaller meals), and avoidance of lying down immediately after meals and exercise. In conclusion, esophagectomy and reconstruction are associated with a variety of complications, and we should work together with surgeons, anesthesiologists, and monitoring room doctors to improve the understanding of the mechanism of complications, cultivate the awareness of timely and comprehensive diagnosis, and master the principles of treatment of complications, so as to achieve the goal of improving the survival time of the patients and the quality of life of patients after the operation.