Objective: To summarise the Clinical experience of esophageal replacement with colon after esophagectomy. Methods: Reviewed the clinical data of 20 patients who underwent esophageal replacement with colon between March 2011 to Mach 2014. 17 patients underwent 3 incisions esophagectomy, colon was extracted behind the sternum, resected the left-half manubrium sterni, left sternoclavicular joint and the first sternocostal joint for the cervical incision; 12 operations were assisted by the thoracoscopy. 3 patients underwent open two-field esophagectomy through right thoracoabdominal incision.Results: No perioperative death. 2 cases with anastomotic leakage of cervical, 2 cases with intestinal fistula, 2 cases with intestinal obstruction, 5 cases with hoarseness, 5 cases with pulmonary infections; the complication rate was 35% (n=7). No ischemic necrosis in the whole section of the interposed colon. Follow up for one or four years, 2 deaths, 2 distance metastasis.Conclusion: For the patients who need the reconstruction of the esophagus but the stomach is unavailable, the better option for the replacement is the colon. Assisted by the thoracoscopy could reduce the surgical trauma. Resecting the left-half manubrium sterni, left sternoclavicular joint and the first sternocostal joint for the cervical incision is helpful for the construction of the substernal pathway, reduction of the anastomotic leakage, and the healing of the fistula.