The substantial improvement in chemotherapy and radiation regimens has led to increasing the rate of surgical intervention in patients with esophageal cancer. The gastric graft is the preferred conduit to establish the gut continuity after esophagectomy for cancer. However, prior gastric surgery and gastric pathological conditions may pose intraoperative difficulties in a subset of patients to safely create the future gastric graft. In these particular situations, alternative options should be considered using an available organ as an alternative conduit. The colon and jejunum grafts are usually used as an alternative conduit to complete reconstruction after esophagectomy when the stomach is unusable. Therefore, the esophageal surgeons should acquire surgical skills and experience to be adept at managing intraoperative difficulties with the conduit preparation.