Abstract: To determine the roles of differen approaches of esophagectom with gastric replacement for esophageal cancer. Method: 446 patients who underwent such resechtions in our department from september 1975 to October 1996 were studied retrospetively. Group Ⅰ (n = 268): left esophago-gashectomy with intrnthoracic anastomosis; Group Ⅱ (n = 49): left esophagectomy with left cervical anastomsis;GrouP Ⅲ (n = 129): right thoracotomy and laparotomy with cervical anastomsis. Conclusion: Subtotal esophagectomy with cervical anastomsis is more radical than intrathoracic procedure, and its higher morbidity does not translate into a higher mortality. Left esophagectomy with introthoracic anastomosis is still an ideal procedure for lower esophgeal carcinoma in most cases, and a stapler is recommended because it is very effective in reducing the incidence of anastomotic leak as well as the mortality.