Background: The narrowness of the thoracic aperture is often an intrinsic problem in retrosternal (RS) reconstruction. We report two cases where compression of the gastric conduit behind the sternoclavicular joint (SCJ) possibly caused intra-cervical gastric conduit bulging. Case Description: The first was a 57-year-old man who underwent a tri-incisional esophagectomy for middle esophageal cancer followed by RS reconstruction. On postoperative day (POD) 5, after initial oral feeding, the patient developed a bulging mass at the location of the cervical incision. However, the patient had no discomfort and tolerated oral feeding well. The second was a 74-year-old man who underwent subtotal esophagectomy for lower esophageal cancer and RS reconstruction. On POD 3, the patient also developed a bulging mass at the neck, which caused stretcher and edema at the incision. We opened the cervical incision and discovered that the etiology was the compression by the SCJ after anastomosis. We could not push the excessive gastric conduit back to the RS tunnel, and subsequently, the patient had to undergo reoperation to transect the bulge. Conclusions: When using the RS route for reconstruction after esophagectomy, it is essential to straighten the gastric tube to ensure no excessive gastric conduit in the cervical zone.
