The left thoracoabdominal approach is an open surgical approach used for resection of large tumors of the esophagogastric junction, unique in its simultaneous approach to the lower mediastinum and epigastrum through a single incision. It provides excellent exposure and allows for adaptation to local conditions, particularly regarding the extension of resection and choice of digestive tract reconstruction graft. This chapter discusses the advantages and drawbacks of such an approach and provide a detailed description of its technical aspects.