Our study compared the Ivor-Lewis and Sweet procedures used for treating middle and lower thoracic esophageal squamous cell carcinoma and assessed the associated perioperative complications and long-term survival rates of the patients.This retrospective study involved 624 middle and lower thoracic esophageal squamous carcinoma patients who received either Ivor-Lewis (n=325) or Sweet (n=299) procedures at our hospital. Further, the perioperative conditions and long-term survival rates were analyzed for both groups.Relative to the Sweet group, the Ivor-Lewis group showed lower volume of drainage within 24hours after operation (400 (300-500) ml vs 550 (400-658) ml, P=.031). Although we found no significant differences in major postoperative complications between the groups (72 (22.2) vs 65 (21.7), P=.90), there were significant differences observed in minor postoperative complications between the Ivor-Lewis and Sweet groups (59 (18.2) vs 32 (10.7), P=.008). Perioperative death rates remained comparable for the 2 groups (2 (0.6) vs 2 (0.7), P>.99). Further, comparison of the 2 groups revealed that the Ivor-Lewis group had increased number of dissected lymph nodes, (20 (4-42) vs 16 (3-31), P<.001), especially in the upper mediastinum (4 (0-5) vs 2 (0-2), P<.001). The long-term survival rates did not differ significantly between the 2 groups (Kaplan-Meier method, P=.95; Cox regression, P=.20).These findings suggest that perioperative complications and long-term survival rates were comparable for both patients groups. Patients receiving the Sweet procedure had reduced minor postoperative complications compared to those receiving the Ivor-Lewis procedure. Due to improved quality of lymph node dissection in the upper mediastinum, the Ivor-Lewis procedure may have advantages over the Sweet procedure for treating patients with esophageal cancer with enlarged lymph nodes in the upper mediastinum.