This chapter underscores the demanding nature of oesophageal and gastric reconstruction, often necessitating surgical intervention in challenging anatomical regions and complex scenarios. The acquisition of requisite skills is emphasised through training and hands-on experience, highlighting variances in training programs across different countries. While specialised training equips surgeons for certain procedures, gaps may exist in handling intricate cases like neck access and managing aerodigestive fistulae. Collaborative efforts with head and neck surgeons and thoracic surgeons are advocated to optimise patient outcomes. Anatomical knowledge emerges as pivotal for planning safe access and understanding pathophysiological nuances, with a call for enhanced training opportunities and accredited centres to foster expertise in complex oesophagogastric surgery.