To investigate the feasibility of simultaneous surgery for pulmonary esophageal cancer. Methods The preoperative diagnosis, surgical approach, postoperative management, and prognosis of 6 cases of concurrent pulmonary esophageal cancer surgery from 1995 to 2007 were retrospectively studied. Results There was no intraoperative death in all 6 patients, 1 case died of a non-primary disease 3 months after surgery, and the remaining 5 cases survived for more than 1 year, with the longest survival being 5 years and 10 months. Conclusion Concurrent surgery for pulmonary esophageal cancer is a feasible treatment method, and patients can obtain better treatment results by paying attention to strengthening the management during the operation period. From April 1995 to October 2007, our department performed combined pulmonary esophagectomy for 3 cases of double primary carcinoma of the esophagus and lung and 3 cases of esophageal bronchial fistula due to invasion of the lung by esophageal carcinoma, and received satisfactory results, which are reported as follows: 1. Clinical data In this group, there were 5 male cases and 1 female case. The age ranged from 52 to 67 years, with a median age of 58 years. Two cases were seen for esophageal cancer symptoms such as “dysphagia”, three cases were seen for pulmonary symptoms such as “cough and hemoptysis”, and one case was seen for “dysphagia and hemoptysis”. Among the three cases of double primary cancer, one case of right upper lobe of lung combined with lower esophageal cancer, one case of right upper lobe of lung combined with middle esophageal cancer, and one case of right lower lobe of lung combined with lower esophageal cancer. Among the 3 cases of esophageal cancer invading the lung, 2 cases of lower segment esophageal cancer invaded the lower lobe of the right lung and 1 case invaded the lower lobe of the left lung. One case of lower segment esophageal cancer invading the lower lobe of the right lung was combined with infiltrative pulmonary tuberculosis in both lungs. 2.Surgical methods All cases underwent combined pulmonary esophagectomy under general anesthesia. Among them, 5 cases were operated through the right side of the chest and 1 case through the left side of the chest. Three cases underwent right lower lobe resection + esophagectomy + gastroesophageal right apex anastomosis, one case underwent right upper lobe resection + esophagectomy + gastroesophageal left neck anastomosis, one case underwent right lower middle lobe resection + esophagectomy + gastroesophageal right apex anastomosis, and one case underwent left lower lobe resection + esophagectomy + gastroesophageal aortic arch anastomosis. Among the 3 cases of double primary cancer, there were 2 cases of squamous adenocarcinoma of lung and 1 case of squamous adenocarcinoma of lung, 2 cases of squamous adenocarcinoma and 1 case of adenocarcinoma of esophagus among the 3 cases of extravasated esophageal cancer. The survival time of the other 5 cases ranged from 1 year to 5 years and 10 months, except for 1 case of lower segment esophageal cancer invading the lower lobe of the right lung combined with bilateral pulmonary invasive tuberculosis who died 3 months after surgery from non-primary disease. 4.Discussion The literature reports that the incidence of multiple primary cancers accounts for about 0.4% to 10.7% of the total number of patients with malignant tumors. Most of them believe that multiple primary cancers mainly occur in paired organs or organs of the same system, especially in the gastrointestinal tract. The literature also reports that GI tract is the most common, and it is more heterochronous. In contrast, esophageal and lung are different systemic organs, and simultaneous double primary cancers are less common. The literature reports that multiple primary lung cancers account for 1-5% of the total incidence of lung cancer and multiple primary esophageal cancers account for 1.73% of the total incidence of esophageal cancer, while dual cancers of lung and esophagus are even rarer, with only one case reported. In this group of cases, a right- or left-sided open chest was used to resect the lung and esophagus with double primary cancer, followed by resection of different parts of esophageal cancer and intrathoracic anastomosis of the stomach instead of esophagus. For esophageal cancer with external invasion forming esophagobronchial fistula, after dissecting the hilum, the invaded lung was resected together with the esophagus, and then gastroesophageal endothoracic anastomosis was performed. The postoperative chest X-ray and chest CT film showed that after lobectomy and gastroesophageal anastomosis, the thoracic stomach was able to fill the thoracic cavity, avoiding the residual cavity formed after lung resection, which can prevent excessive atrophy and expansion of the lung resulting in hemodynamic changes and facilitate the reshaping of the thoracic organs and functional recovery. In patients with pulmonary tuberculosis, the filling of the thoracic stomach to the cavity of the resected diseased lung, the remaining lung will not be over-expanded or displaced, which can prevent and control the recurrence and spread of pulmonary tuberculosis, facilitate the stabilization of pulmonary tuberculosis, prevent deterioration, and promote postoperative recovery. In the case of right thoracotomy, pyloroplasty is feasible and attention is paid to the morphology of the stomach to prevent obstruction due to pyloric angulation, spasm and gastric torsion. Esophageal and pneumonectomy require both extensive surgical experience and perfect perioperative management because of the large surgical trauma, long duration, and large impact on respiratory function. Preoperative active control of respiratory tract infection, supplementation of colloid fluid, and improvement of plasma colloid pressure may help to reduce postoperative complications. Intraoperatively, double-lumen anesthesia intubation should be used to reduce extrusion of the lung; for poor lung function, wedge resection of the lung or segmental resection of the lung is appropriate to maximize preservation of lung function and avoid total lung resection as much as possible. Postoperatively, ventilator-assisted ventilation should be continued, and tracheotomy should be performed if necessary. For postoperative coughing and poor sputum excretion with pulmonary atelectasis, application of fibrinoscopic aspiration is an effective method. Postoperative fasting can lead to insufficient electrolyte and trace element intake, which can weaken cardiac function during the recovery period and often lead to arrhythmias, such as supraventricular tachycardia and atrial fibrillation. The surgery is traumatic and emergency ulcers should be prevented. We routinely apply gastric mucosa-protective drugs for 3-5 days after surgery, which effectively prevents such complications. For postoperative nutritional support, we experience early (3 days after surgery) enteral nutrition through duodenal nutrition tube, which can reduce the amount of fluid input and reduce the cardiopulmonary burden. It also avoids intestinal flora dysbiosis due to long-term fasting. Postoperatively, the gastric tube and chest drain should be kept open to prevent thoracic and gastric dilatation and to promote pulmonary resuscitation. Kato et al. reported that the mortality, intraoperative blood loss and postoperative complications of simultaneous surgical resection of esophageal lung were not significantly different from those of resection of esophageal cancer in the thoracic segment alone. We believe that combined esophageal-pulmonary resection is a feasible and effective treatment for esophageal cancer invading the lung or double primary esophageal-pulmonary cancer with prolonged survival as long as the indications for surgery are strictly mastered, preoperative preparation of the respiratory and cardiovascular systems is actively performed, unnecessary injuries are avoided during surgery, and postoperative complications are reduced.