Abstract: Objective : To examine the efficacy of the modified Ivor-Lewis esophagectomy for middle third thoracic esophageal cancer. Methods : Records were reviewed for a total of 241 patients with squamous cell carcinoma in the middle third of the thoracic esophagus who underwent Ivor-Lewis esophagectomy with two-field lymphadenectomy from 1997 through 2001. Survival rate was calculated using the Kaplan-Meier method. Cox regression analysis was performed to identify prognostic risk factors. Results : Peri-operative complications occurred in 40 patients (16.6%) and death occurred in 6 patients (2.5%). The overall 5-year survival rate was 31%, and the 5-year survival rate for patients with stage Ⅰ, stage Ⅱ_A, stage Ⅱ_B, and stage Ⅲ disease was 72%, 40%, 16% and 13%, respectively (P<0.001). Local recurrence rate (23.3%) was lower in patients with N₁ or T₃ disease receiving radiotherapy after surgery, compared to that (41.3%) in patients without radiotherapy (P<0.05). In Cox analysis positive lymph nodes (HR=2.074, P<0.01) and T₃ tumors (HR=3.493, P<0.01) were prognostic risk factors. Conclusion : Ivor-Lewis esophagectomy for the middle third thoracic esophageal cancer is a safe surgical operation. Post-operative radiotherapy was helpful to control local recurrence. Long-term survival is T₃ and N₁ stage dependent. Most patients with T_{1N0M0 and T2N0M0 disease could be cured by this procedure, while poor Results were associated with T3 and N1 stage disease.}