Abstract: Objective To study the value of multi-slice spiral CT in tracking and evaluating the postoperative images of esophageal cancer patients treated with different surgical procedures. Methods Total 60 patients with esophageal cancer were selected from the First People's Hospital of Chuzhou City from April 2014 to June 2018. The patients were divided into two groups and were treated with left and right thoracic approach, which includes 30 cases respectively. The treatment was followed-up with multi-slice spiral CT 1 to 3 days, or 1 week after operation and multi-slice spiral CT was performed for the patients every 3 months within the next two years after discharge. The types and cases of short-term and long-term complications were analyzed. The incidence and imaging characteristics in the two groups of different complications after operation were also analyzed. Multiple regression analysis was used to analyze the relationship between different surgical procedures and short-term and long-term complications. Results On 128-slice spiral CT scans, there were 28 cases of pulmonary inflammation, 58 cases of pleural effusion, 36 cases of atelectasis, 22 cases of hydropneumothorax, 36 cases of subcutaneous emphysema of chest wall, 7 cases of pneumomediastinum, 7 cases of anastomotic fistula, long-term anastomotic stenosis occurred in 6 cases, tumor recurrence in 7 cases, metastasis in 44 cases (including lymph node, bone, liver, lung, brain, adrenal, pleuroperitoneum and other organs). The incidence of pulmonary infection and anastomotic fistula in the right thoracic approach group of esophageal cancer were lower than those in the left thoracic group (all P<0.05). There was no difference in the incidence of the other complications among the groups (all P>0.05). There was a correlation between operation mode and pulmonary infection and anastomotic fistula (all P<0.05), no significant correlation with other recent and long-term complications (all P>0.05). Conclusion The incidence of pulmonary infection and anastomotic fistula in the right thoracic group are lower than those in the left thoracic group. CT could evaluate the common postoperative complications, and provide evidence for clinical active treatment directly and accurately.