Introduction & Objective: Esophageal cancer is one of the most fetal and poor-prognosis cancers and is very common in Iran. The main treatment for this cancer is surgery which may be performed with either trans-thoracic (TTE) or trans-hiatal esophagectomy (THE). Each of these methods has specific morbidities and mortalities. So, the choice between their has been controversial. In this study, the outcomes of these two approaches were compared for the case of Iranian patients.Materials & Methods: In this descriptive cross-sectional survey, we studied 100 patients with esophageal cancer who had undergone operation with either TTE or THE in Shohada-E-Tajrish Hospital, Tehran, during 2000-2008. Patients in the two groups were matched for age, sex, duration of dysphagia, surgical grading, pathologic type, tumor location, and background diseases. Analysis was performed by Mann-Whitney, Independent-Sample T, Chi-Square, and Fisher tests.Results: The mean age of the patients was 61 years. Mortality and morbidity rates were the same across the groups (P > 0.05); except for anastomosis leak that was more frequent in the trans-hiatal approach (six versus three cases) with odds ratio of 1.4 (95% Confidence Interval, 1.3-1.6), and also the duration of operation was longer in the trans-thoracic surgeries with odds ratio of 1.3 (95% Confidence Interval, 1.2-1.4) for a duration of longer than five hours (P < 0.05).Conclusions: According to these findings, trans-hiatal and trans-thoracic approaches for esophagectomy have not statistically significant difference in the outcomes. So, each procedure may be chosen, considering physician's opinion and patient's condition.