Next, we turned our attention to performing the thoracic portion of the procedure.  The patient was placed in the left lateral decubitus position.  The right chest was prepped and draped appropriately.  We then used a #10 blade scalpel to make an incision in a posterolateral, non-muscle-sparing fashion.  Dissection was carried down to the level of the ribs with Bovie electrocautery.  Next, the ribs were counted and the 5th interspace was entered.  The lung was deflated.  We placed standard chest retractors.  Next, we incised the peritoneum over the esophagus.  We dissected the esophagus to just above the azygos vein.  The azygos vein, in fact, was taken with 0 silk ligatures and reinforced with 2-0 stick ties.  As mentioned, we dissected the esophagus both proximally and distally down to the level of the hiatus.  After doing this, we backed our NG tube out to above the level where we planned to perform our pursestring.  We used an automatic pursestring and applied.  We then transected the proximal portion of the stomach with Metzenbaum scissors.  We secured our pursestring and then placed a 28 anvil in the divided proximal portion of the esophagus.  The pursestring was then tied down without difficulty.  Next, we tabularized our stomach using a #80 GIA stapler.  After doing so, we chose a portion of the stomach more distally and opened it using Bovie electrocautery.  We placed our EEA stapler through it and then punched out through the gastric wall.  We connected our anvil to the EEA stapler.  This was then secured appropriately.  We checked to make sure that there was appropriate muscle apposition.  We then fired the stapler.  We obtained 2 complete rings, 1 of the esophagus and 1 of the stomach, which were sent for pathology.  We also sent the gastroesophageal specimen for pathology.  Of note was the fact that the frozen section showed no evidence of tumor and in the proximal distal margins.  We then turned our attention to closing the gastrostomy opening.  This was closed with 2-0 Vicryl in a running fashion.  We then buttressed this with serosal 3-0 Vicryl interrupted sutures.  We returned the newly constructed gastroesophageal anastomosis into the chest and covered it by covering the pleura over it.  Next, we placed two #28-French chest tubes, 1 anteriorly and 1 posteriorly, taking care not to place it near the anastomosis.  We then closed the chest with #2 Vicryl in an interrupted figure-of-eight fashion.  The lung was brought up.  We closed the muscle layers with #0 Vicryl followed by #0 Vicryl; then we closed the subcutaneous layer with 2-0 Vicryl and the skin with 4-0 Monocryl.  Sterile dressing was applied.  The instrument and sponge count was correct at the end of the case.  The patient tolerated the procedure well and was extubated in the operating room and transferred to the ICU in good condition.