In order to find out the incidence, treatment and prevention of post colonic replacement for esophagus, analyses of the clinical materials of 260 such cases were performed. The results showed that in the early 100 cases, the postoperative morbidity rate was 39% and it declined to 10.6% in the later 160 cases. The overall mortality was 2.30%. The postoperative complications in the early and late cases consisted of leakage of cervical anastomosis (28 vs 8), recurrent nerve injury(3 vs 1), intestinal obstruction(3 vs 0), respiratory failure(2 vs 1), septicemia(2 vs 0), anastomosis stenosis(2 vs 2), thoracic colon syndrome (3 vs 2), blind esophageal pouch syndrome(2 vs 1) and others (2 vs 2). The measures taken for preventing colon necrosis were preservation of good colon blood supply with satisfactory blood pressure, avoidance of undue pressure on and twisting of the colon segment. For reduction of cervical anastomosis leakage, good blood supply, proper one stitch whole layer anastomosis, iso-peristaltic anastomosis without obstruction, minimal contamination of the operative field and adequate gastric decompression are essential measures to be taken. Laryngeal nerve injury can be avoided by gentle surgical technique with good visualization and adequate anatomical knowledge. In preventing postoperative intestinal obstruction, attention must be paid to the choice of the route through which the colonic segment was pulled up to the neck. In case of pregastric route, a dumb-bell stomach can occur if the colon segment is too tightly pressing the stomach; the colonic segment may be pinched by the rectus muscle or the tight diaghram. Intestinal obstruction can also caused by intestinal hernia through the not tighlty closed mesenteric incision. Technical precautions should be taken to avoid the causes enlisted above. Cervical anastomosis stenosis is usually the result of healing of anastomosis leakage by scar formation or the long-term result of corrosive injury of the adjacent esophagus. During operation, the damaged part of the esophagus should be thoroughly resected before anastomosis starts. Thoracic colon syndrome is commonly produced by: (1) too big anastomosis orifice, (2) anastomosis site too close to the pylorus, (3) angulation of the long intra-abdominal colon segment, (4) hypertrophic stenosis of pylorus. Modification of the anastomosis techniques to correct the above enlisted items is the answer of prevention. In severe cases, however, reoperation is necessary. Esophageal pouch syndrome is the clinical manifestation of mucus accumulation in the exteriorized blind esophageal pouch. Preventive measures include (1) avoidance of end to side anastomosis, (2) resection of the pathological part of the esophagus at one situ, (3) complete destruction of the mucosa of the exteriorized part of the esophagus. Early resection of the esophageal pouch may be mandatory in severe cases. The authors conclude the incidence of complications of esophageal replacement with colon can be reduced, and proper management including surgical intervention must be considered when clinical situations require.