This guideline is jointly developed by the Chinese Society of Esophageal Diseases and the Guangdong Thoracic Diseases Society. Based on existing literature and the clinical experience of the participating experts, the guideline summarizes the application of non-intubation anesthesia technique in thoracoabdominal laparoscopic esophagectomy (the McKeown procedure), aiming to provide practical references for medical centers that intend to implement the McKeown. The guideline systematically outlines the indications and contraindications of non-intubated anesthesia, emphasizing patient selection criteria such as American Society of Anesthesiologists (ASA) class ≤2 and good cardiopulmonary function, while excluding severe comorbidities or airway abnormalities. Preoperative preparation includes comprehensive evaluation, nutritional support, cardiopulmonary exercise, and dietary adjustments. Anesthetic techniques involve epidural anesthesia, thoracic paravertebral nerve block, and laryngeal mask airway placement, with two recommended anesthesia protocols for optimized intraoperative management. The surgical workflow details patient positioning, incision design, and key steps in thoracic, abdominal, and cervical operations, highlighting the advantages of minimally invasive techniques and spontaneous ventilation management. Anesthesia management focuses on preventing and addressing complications such as hypercapnia, hypoxemia, and laryngeal mask displacement, with clear criteria for conversion to tracheal intubation. Postoperative analgesia adopts a multimodal strategy to enhance recovery. The guideline concludes that non-intubated anesthesia offers advantages of reduced trauma and faster recovery but requires individualized management to ensure safety. With technological advancements, this approach is expected to further promote minimally invasive esophageal cancer surgery.