Objective:To compare 2 surgical approaches for radical esophagectomy and discuss which is a better operative pathway of lymphadenectomy. Methods:Clinical data of 96 patients of thoracic incision and 117 of left abdominothoracic incision with squamous cell carcinoma of the lower esophagus, who underwent radical esophagectomy from Jan 2000 to Jan 2005 in the first affiliated hospital of Sun Yetsan Universtiy,were analyzed retrospectively. Compared was made on number of lymph node resected, regional lymph node metastasis ratio,perioperative mortality,operation time,bleeding volume,surgical complication rate,postoperative hospital stay,median survival period between the 2 groups. Results:There was significant difference in superior mediastinum,and lymph node of the 1st,2nd group abdomen between 2 groups (P<0.05),but there were no significant difference between 2 groups (P>0.05) in the perioperative mortality,operation time,bleeding volume,surgical complication rate,postoperative hospital days,survival rate. Conclusion:Left thoracic incision is more effective on lymphadenectomy of superior mediastinum,Whereas abdominothoracic incision shows more effective on lymphadenectomy of abdominal region.