Objective:Lymph node involvement may impact postoperative therapeutic decision-making and prognosis in patients undergoing esophagectomy. This article is a prospective study of the total and the reginal lymph nodes dissection methods of the two surgical approachs (Ivor Lewis and left posterolateral thoracic approach). Methods:All 121 cases of middle and lower thoracic esophageal carcinoma from July 2010 to July 2011 were randomly divided into two groups,Ivor Lewis group with 41cases and left posterolateral thoracic approach group with 80 cases. Comparison was made on the number of lymph node resected,the number of each reginal lymph nodes resected,lymph node metastasis rate and degree,operation time,the volume of introperative blood loss,postoperative chest tube drainage,postoperative hospital stay,surgical complication rate. Results:There were significant differences in the resected number and metastasis rate of superiormediastinum lymph node,operation time,the volume of introperative blood loss between the two groups(P < 0.05). But there was no significant difference between two groups in the other factors(P > 0.05). Conclusion:Ivor Lewis approach has more advantages in the resection of superiormediastinum lymph node and is able to give a accurate evaluation on the postoperative pathological stage and guide the next treatment.