Abstract: Objective : To compare and analyze the advantages and shortcomings of different surgical approaches forgastroesophageal junction carcinoma and to explore the optimal surgical approach to treat gastroesophagealjunction carcinoma. Methods : We retrospectively analyzed the data of 95 cases of gastroesophageal junctioncarcinoma seen in our hospital between June 2006 and July 2007. Results : The incidence of preoperativecomplications were significantly higher in the group treated with transabdominal surgery than in the group treatedwith trans-left thoracic surgery or the group treated with thoracoabdominal surgery ( P =0.006). The incidence ofsevere postoperative complications was lower in the group treated with transabdominal surgery than in the othertwo groups ( P =0.061). There were 4 cases with positive upper incisal margin (12.1%) in the group treated withtransabdominal surgery, a higher percentage than that found in the group treated with thoracoabdominal surgery(9.5%) or the group treated with trans-left thoracic surgery (0). The surgery duration in the transabdominal ap-proach group was similar to that of the trans-left thoracic approach group, but it was shortest in the thoracoab-dominal approach group ( P <0.001). The rate of positive lower incisal margin was 7.3% in the trans-left thoracicapproach group. The rates of inferior mediastinum lymph node dissection and metastasis were significantly higherin the trans-left thoracic approach group than in the transabdominal surgery group or the thoracoabdominal surgerygroup ( P <0.001). The rates of inferior mediastinum lymph node metastasis were 41.5%, 23.8%, and 3.0% in thetrans-left thoracic approach group, the thoracoabdominal approach group and the transabdominal approach group,respectively ( P =0.001). Conclusion : For patients who can tolerate transthoracic surgery, trans-left thoracic surgerycan better achieve excision extension and lymph node dissection. The thoracoabdominal approach should beavoided for elderly patients or patients with poor cardiopulmonary function and severe preoperative conditions.Thoracoabdominal surgery should be performed for patients with type Ⅰ and Ⅱ gastroesophageal junctioncarcinoma. For type Ⅲ gastroesophageal junction carcinoma, transabdominal or thoracoabdominal surgery canbe chosen according to the results of exploratory laparotomy.