The length of the esophagus is approximately 22 cm. Tumor spread can occur through the submucosal route and also through locoregional lymph nodes. The lymph nodes drain along the arterial supply to the esophagus, which is predominantly supplied by the inferior thyroid artery, esophageal branches from the thoracic aorta, and branches from the left gastric artery. The transthoracic esophagectomy procedure involves placing the patient supine. A laparotomy is performed to assess for any evidence of disease in the abdominal cavity. The stomach is mobilized, with preservation of the right gastric and right gastro-omental arteries. The short gastric vessels and left gastric vessels are divided, and a pyloromyotomy is also performed.