Esophageal anastomotic leaks are associated with significant morbidity and mortality. The purpose of this study was to retrospectively assess the role of the anastomotic positioning (thoracic or cervical) on the incindence of the anastomotic leak and its severity.In the period 2002-07, we have performed extended esophagectomy with a curative-intent in 63 patients with esophageal cancer. The clinical outcome of the 46 patients where a cervical anastomosis was performed (Group A) has been compared with that of the 17 with thoracic anastomosis (Group B), in terms of leak incidence, pattern of healing, morbidity, and mortality.Leaks occurred in 11% patients of the in group A and in 8% of the group B. When the dehiscence has occurred in the cervical region 1/4th of patients died before the 30th post-operative day compared to the 3/5th of those where the leak occurred at the level of the thorax.On the basis of our findings we suggest the adopt the cervical anastomosis due to lower mortality rate related when leaks occur.