The patient was a 50-year-old man who visited our hospital on February 10, 2020 due to "progressive dysphagia for 3 months". Gastroscopy suggested a mass at 23–28 cm from the incisors, involving the full circumference of the esophagus. The biopsy provided a result of squamous cell carcinoma. Endoscopic ultrasonography revealed involvement to the esophageal fibrous membrane. The result of a CT examination showed a RAA with a tumor in the middle and upper thoracic segments of the esophagus surrounded by enlarged lymph nodes (Fig. 1). Gastroscopic biopsy specimen were taken for Programmed Death Receptor Ligand-1(PD-L1) detection and the result provided a TPS of 10%. Cranial Magnetic Resonance Imaging(MRI), bone scan, and abdominal CT showed no sign of metastasis, with the clinical stage as c-T3N1M0, stage Ⅲ. Because CT indicated a larger volume of the tumor, with signs of outward invasion along with vascular malformations (Fig. 2), neoadjuvant immunotherapy combined with neoadjuvant chemotherapy was given considering the great difficulty to perform a surgery directly. The treatment regimen is described with details below: 1. Sintilimab 200 mg, once every three weeks [2]; 2. Nab-paclitaxel 400 mg + Cisplatin 100 mg, once every three weeks (1.6 m2 for body surface area, 90 points for KPS score) [3].After three cycles of neoadjuvant therapy, this patient achieved a fully clinical symptom remission and had been able to take the dry and hard food. Re-examination of chest CT revealed tumor shrinkage (Fig. 3). No distant metastasis was observed on the Positron emission tomography/Computed tomography (PET/CT). Therefore, after preoperative discussion, the surgical treatment was determined. There was no abnormal observation in preoperative cardiopulmonary function and other measures, without any surgical contraindications. Whereupon, on April 26, 2020, the patient underwent thoracic laparoscopy via left thoracic approach combined with esophagectomy + stomach replacing esophagus cervical anastomosis + lymph node dissection under general anesthesia. Findings during the operation include: superior mediastinal vascular malformation, left subclavian artery arising from the left to the right from the aortic arch, crossing above the esophagus (Fig. 4). The mediastinal pleura was opened along the periphery of the tumor to separate the space between the esophagus and the descending aorta, left subclavian artery, trachea, and left innominate vein; after freeing along the posterior wall of esophagus to the level of the left subclavian artery, it was difficult to continue on the esophageal tumor. Therefore, after dissection of paraesophageal lymph nodes, subcarinal lymph nodes, and left recurrent laryngeal nerve chain lymph nodes, the body position was changed, and an incision along anterior border of left sternocleidomastoid muscle was made at the neck by opening layer by layer, and fully freeing was made along the esophageal space until to the level of the left subclavian artery to completely removal esophageal tumor. Eostoperative pathology showed the involvement of esophageal tumor to the superficial muscular layer of esophagus and no metastasis observed in lymph node, with the postoperative stage as yp-T2N0M0, stage I. The patient was discharged on the 8th day after the operation, without complications. Following the treatment of surgery, immunotherapy and chemotherapy were continued with the preoperative medication regimen. Up to the present, it has been 11 months after operation, and on the follow-up, the patient has no sign of recurrence or metastasis.