Abstract: Objective: To investigate the regularity of thoraco-abdominal two-field lymphatic metastasis and method of the nodal dissection in middle-third thoracic esophageal carcinoma, and to guide the scope of the lymph-node clearance. Methods:Thoraco-abdominal two-field lymph-node dissection based on surgical incisions of the right chest and middle up-per abdomen were conducted in 95cases with middle-third thoracic esophageal cancer and the regularity of nodal metasta-sis was analyzed. Results:The nodal metastasis ratio of the 95patients was 20.4%. The infiltration depth and differentiation of the tumor is of statistical significance on the nodal metastasis ratio. The middle-third thoracic esophageal cancer not only includes the nodal metastases up to the trachea of the right neck, around the bilateral recurrent laryngeal nerve chains, near the esophagus and the tumor, and the lymph-node metastasis at the inferior tracheal protuberance, but also the nodal metastases down to the cardia, around the left gastric artery and at the retina of the lesser curvature of the stomach etc., presenting a tendency of 2-way metastasis. Conclusion:The lymph node metastasis of patients with middle-third thoracic esophageal carcinoma was significantly correlated with the depth of tumor invasion and the degree of differentiation, with the tendency of thoraco-abdominal 2-field nodal metastasis. The peri-tracheal lymph node at right neck and bilateral recur-rent laryngeal nerve chains are important regions of the metastasis. The surgical incision of the right thorax and upper ab -domen greatly facilitates the excision of the middle-third thoracic esophageal cancer and the2-field lymph node dissection. Thus on this basis, the lymph node clearance around the right trachea and at bilateral recurrent laryngeal nerve chains through the right thoracic apex is safe and feasible.