Abstract: Objective: To investigate the clinical significance of exposure of laryngeal recurrent nerve in left neck gas -tro-esophagus anastomosis in the surgery for middle/lower esophageal carcinoma. Methods:From January 2003 to April 2009, 237 cases of esophageal carcinoma received gastro-esophagus anastomosis on the left neck. All cases were patho -logically identified as squamous cell carcinoma. The 237 case were divided into two groups. Group A ( 115 cases) had expo-sure of laryngeal recurrent nerve. There were 64males and 51females in group A, ranged in age from 31to 73years with a mean of 49years. Group B ( 122 cases) did not have laryngeal recurrent nerve exposed during surgery. There were 51 males and 71females in group B, ranged in age from 33to 75years with a mean age 45years. Results:A total of 9 cases had symptoms of laryngeal recurrent nerve injury in the two groups. One patient in group A appeared hoarseness, irritation and cough. Eight patients in group B appeared hoarseness, irritation and cough. The difference in the incidence of injury of laryngeal recurrent nerve was significant between the two groups ( P<0.05). Conclusion:Exposure of laryngeal recurrent nerve in left neck gastro-esophagus anastomosis in the surgery for middle/lower esophageal carcinom resulted in lower in-cidence of injury of laryngeal recurrent nerve and is recommended.