Three hundred thirty-eight patients with carcinoma in the middle and lower thirds of the esophagus received Ivor-Lewis esophagogastrectomy (separate laparotomy and right thoracotomy incisions) from February 1986 to June 1992. The total resectability was 95.2%. Lymph node metastases were found in 136 cases (40.2%). Postoperative complications developed in 10.3% of the patients. No anastomotic leakage, nor postoperative (within 30 days) death and hospital death occurred. Major pulmonary complications occurred in 28.6% of the patients. The overall 1-, 3- and 5-year survival rate was 88.5% (231/261), 63.1% (125/198) and 48.4% (60/124), respectively. The 5-year survival rate was 64.1% (41/64) in patients with negative lymph nodes as compared to 31.7% (19/60) with positive nodes. The superiority of this technique was a significant improvement of the 5-year survival rate. This was due to better exposure of the operation field which made thorough dissection of lymph nodes possible, especially those along the right recurrent laryngeal nerve. Better operative exposure also provided chances for radical resection with less interference from the aortic arch. It made anastomosis easier to perform so that stenosis and leakage were less fikely to occur. Ivor-Lewis esophagogastrectumy was a superior surgical procedure of choice for the treatment of cancer at the lower and middle thirds of the esophagus.