We report a case of successful esophagectomy via a left thoracotomy for esophageal cancer in a 57-year-old Japanese man with situs inversus totalis. An upper gastrointestinal endoscopy, performed to investigate the cause of dysphagia, revealed a 7-cm irregular shaped mass occupying more than half of the circumference of the middle-third of the esophagus. Computed tomography (CT) showed enlarged mediastinal lymph nodes and situs inversus totalis. Histological examination of a biopsy specimen revealed squamous cell carcinoma of the esophagus. Although esophagectomy is usually performed through a right thoracotomy because of the left position of the aortic arch, we performed successful subtotal esophagectomy with radical lymph node dissection through a left thoracotomy. During surgery, we modifi ed the standard surgical technique in a mirrorimage fashion to complete the esophagectomy safely. The patient had an uneventful postoperative course.