Abstract: Objective: To compare the effects of three different surgical procedures on middle-lower sec -tion esophageal cancer. Methods:From January 2000 to December 2007, data from 300 patients with mid -dle-lower section esophageal carcinoma who underwent three different surgical procedures were reviewed. Patients in Group 1 had manual anastomosis in the left neck. Patients in Group 2 had staple anastomosis in the left chest cavity through the esophageal bed. Patients in Group 3 had staple anastomosis in the left chest cavity beside the esophageal bed. Each group included 100 patients. We evaluated indices including surgical duration, chest and gastric tube drainage volume, intestinal movement, cardiac arrhythmia, anastomotic leak-age, pulmonary function before and 3 months after surgery, and esophageal stricture and regurgitation 3 months after surgery. Results: There was no surgery-related death. Pathological detection showed 289 cases of squamous carcinoma,4 cases of small cell carcinoma, 4 cases of carcinoid tumor, and 3 cases of adeno -carcinoma. Group1 had lower surgical expenses, a higher rate of morbidity, longer surgical duration, and a lower rate of postoperative esophageal stricture. Group 2 had shorter surgical duration, less chest tube drain -age, a lower cardiac arrhythmia rate, milder esophageal regurgitation, and less pulmonary function damage. Conclusion:Staple anastomosis in the left chest cavity through the esophageal bed can achieve better results than the other two surgical procedures. The treatment decision should be made considering tumor location, patients’economic situation, pulmonary function, and the surgeon’s technique.