Background During esophagectomy for esophageal cancer, a gastric tube is necessary for the perioperative period. However, the gastric tube and anastomotic anvil placement is often extremely difficult and time consuming during surgery. Methods We used the traditional method or improved method to place the gastric tube and anastomotic anvil during thoracoscopic and laparoscopic Ivor Lewis esophagectomy. Thirty-seven patients were in the improved group: the gastric tube and anastomotic anvil were placed using the improved method; 35 patients were in the traditional group: the gastric tube and anastomotic anvil were placed using the traditional method. Retrospectively, we analyze the basic clinical characteristics, perioperative clinical features, and postoperative complications of the two groups of patients. Results The two groups were matched well for baseline characteristics. There was no significant difference between the two groups in blood loss, postoperative hospital stay, postoperative fasting time, drainage volume, and overall complications. But significant between-group differences were observed in time consuming and chest tube indwelling time (P < 0.05), both of which were significantly shorter in the improved group than in the traditional group. Conclusions This improved method can reduce the difficulty of placing anastomotic anvil and gastric tube and prevent damage to the anastomosis during surgery.