Abstract:Objective To compare baseline characteristics，intraoperative outcomes，and postoperative complications between patients undergoing total laparoscopic versus open Ivor Lewis esophagectomy. Methods The clinical data of 188 esophageal cancer patients who underwent Ivor Lewis esophagectomy at Nanjing Drum Tower Hospital，the Affiliated Hospital of Nanjing University Medical School from December 2021 to May 2024 were retrospectively collected. According to whether the total laparoscopic and thoracoscopic Ivor Lewis esophagectomy was adopted，they were divided into the total laparoscopic group（group T，n=130）and open esophagectomy group（group O，n=58）. The surgical conditions and complications of the two groups of patients were analyzed. Results Baseline：there was no significant difference between the two groups in age，neoadjuvant therapy，history of malignant tumor，tumor location，pathological type and pathological stage（P>0.05）. The proportions of women and basic diseases in group T were higherthan those in group O（P<0.05）. Operation situation：the negative rate of the esophageal stump margin was 100% in both groups. Compared with group O，group T had less intraoperative bleeding［（173.9±78.3）mL vs（246.6±68.1）mL，t=6.113，P<0.01］，a greater number of lymph node dissection［（19.9 ± 7.9）vs（17.0 ± 6.5），t=2.449，P<0.05］，and shorter hospital stay［（12.2±2.4）days vs（13.5±3.4）days，t=2.634，P<0.05］，but longer operative time and higher hospitalization costs（P<0.01）. Complications：there was no statistically significant difference in the incidences of lung infection，anastomotic leakage，recurrent laryngeal nerve injury，thoracic puncture catheter placement，and secondary surgery between the two groups（P>0.05）. The incidence of pleural effusion in group T was higher than that in group O（P<0.01），while the severity of pain score was lower than that in group O（P<0.01）. Conclusion Compared with the open esophagectomy，although total laparoscopic will prolong the operation time，increase hospitalization expenses，and increase the incidence of pleural effusion，it has obvious advantages in reducing intraoperative blood loss，increasing the number of lymph node dissections，shortening the hospital stay，and alleviating postoperative pain，and is a safe and feasible surgical method.