Objective To compare the effects of minimally invasive Ivor-Lewis esophagectomy (MIILE) and minimally invasive McKeown esophagectomy (MIME) in the treatment of middle and lower esophageal cancer. Methods 60 patients with middle and lower esophageal cancer in our hospital from January 2015 to January 2017 were selected and divided into MIILE group (34 cases) and MIME group (26 cases). MIILE group was given minimally invasive IvorLewis esophagectomy, and MIME group was given minimally invasive McKeown surgery. The surgery-related status, incidence rate of complications and recurrence rate within 1 year were compared between the two groups. Results The results showed that the duration of operation, catheterization time and hospital stay in MIILE group were significantly lower than those in MIME group (P<0.05), and there were no significant differences in the intraoperative blood loss and lymphatic dissection quantity between the two groups (P>0.05). The incidence rate of complications in MIILE group was not significantly different from that in MIME group (8.82% vs 15.38%) (P>0.05). At 1 year of followup, the recurrence rate was 8.82% in MIILE group and 7.69% in MIME group (P>0.05). Conclusion Both MIILE and MIME are important procedures for middle and lower esophageal cancer, but MIILE can shorten the duration of operation, catheterization time and hospital stay, and its short-term efficacy is better than MIME.