The incidence of esophageal adenocarcinoma has increased significantly in recent years. Early detection of a small mucosal tumor by endoscopy is occurring more frequently. This, together with improved results of surgical treatment, has created a new population of patients with prolonged post-esophagectomy survival. Adenocarcinoma in the reconstructed gastric tube is no longer a rare finding and is expected to be even more common in the future. We report a case of a patient treated for metachronous gastric tube carcinoma and discuss the steps of the surgical procedure.