Surgical treatment of gastric tube cancer after thoracic gastrectomy is highly invasive, especially for gastric tube cancer of the posterior mediastinal tract, and in some cases, a reduction surgery is an option. We have experienced 4 cases of posterior mediastinal reconstructive gastric tube cancer in which local resection by thoracoscopic and endoscopic cooperative surgery( TECS)was conducted. All cases had undergone video-assisted thoracoscopic subtotal esophagectomy and posterior mediastinal gastric tube reconstruction for thoracic esophageal cancer. In 1 case, endoscopic submucosal dissection was performed, but it showed positive for vertical margins. Other cases were not indicated for endoscopic resection. Considering the patient's background, we decided to preserve the gastric tube and planned local resection by TECS. One patient was transferred to open thoracotomy due to severe adhesion, and 1 patient underwent segmental resection and 2-stage reconstruction due to narrowing of the gastric tube lumen at the suture closure. In all cases, the resection margins were negative and the patients are alive without recurrence of gastric tube cancer. Local resection of gastric tube with TECS for posterior mediastinal tract reconstructive gastric tube cancer may be useful as a less invasive surgical treatment.