The objective of this paper is to study the treatment outcome of postoperative adjuvant radiation therapy in Ivor Lewis esophagectomy with two-field lymphadenectomy (2FL) and evaluate whether the method can replace three-field lymphadenectomy (3FL). We collected a consecutive series of 503 patients who had undergone Ivor Lewis esophagectomy with 2FL over a seven-year period in our department and evaluated the therapeutic efficacy of postoperative adjuvant radiation therapy. Recurrence and survival rates were calculated with the Kaplan-Meier method, and the differences were compared by the log-rank test. Logistic regression analysis was used to test risk factors for postoperative lymph node metastasis. Cox regression analysis was used to identify prognostic risk factors. The overall 3- and 5-year survival rates were 62.8 and 34.4 %, respectively. There was a significant difference in 5-year survival rate between patients received adjuvant radiation therapy and did not receive radiation therapy. Postoperative adjuvant radiation therapy for patients who underwent Ivor Lewis esophagectomy with 2FL may offer the patients significant survival benefits and reduces the incidence of recurrence in cervical and superior mediastinal lymph nodes.