Objective: To analyze of gastric left paracentral lymph node metastasis and its risk factors after minimally invasive radical surgery in patients with thoracic esophageal cancer. Methods: The data of 212 patients undergoing minimally invasive radical surgery for thoracic esophageal cancer from January 2014 to March 2019 were reviewed and analyzed. The incidence of lymph node metastasis along theleft gastric artery after operation was statistically analyzed, and the patients were divided into occurrence group and non occurrence group by this. Then the risk factors were analyzed. Results: 48 cases had lymph node metastasis along theleft gastric artery, and the incidence was 22.64%. The proportions of low differentiation, T3 stage, tumor > 5 cm, vascular cancer thrombus and positive internal margin in the occurrence group were higher (P<0.05), while radiotherapy and chemotherapy were lower than those in the non occurrence group (P<0.05). Logistic regression analysis showed that low differentiation, T3 stage, tumor >5 cm, vascular tumor thrombus and positive internal margin were independent risk factors for lymph node metastasis along theleft gastric artery after minimally invasive radical resection of thoracic esophageal carcinoma (OR=2.883, 2.227, 5.369, 7.643, 4.904, P<0.05). Radiotherapy and chemotherapy were the protective factors (OR=0.755, 0.917, P<0.05). Conclusion: Low differentiation, T3 stage, tumor >5 cm, vascular tumor thrombus and positive internal margin can increase the risk of lymph node metastasis along theleft gastric artery after minimally invasive radical resection of thoracic esophageal carcinoma, and prevention and control should be strengthened for those with the above risk factors, while radiotherapy and chemotherapy can decrease the risk, and patients with indications of radiotherapy and chemotherapy should be given radiotherapy and chemotherapy as soon as possible.