Objective <p>To explore the validity and feasibility of a minimally invasive single-position left transthoracic and esophageal hiatal approach for Siewert type II adenocarcinoma of the esophagogastric junction.</p> Methods <p>Clinical data of 196 patients with Siewert type II AEG treated by the same surgical team from January 2017 to December 2019 at our institution were retrospectively analyzed. Patients were categorized into the minimally invasive single-position left transthoracic and esophageal hiatal approach (SLTEA) group (<i>n</i> = 106) and the minimally invasive laparoscopic transesophageal hiatus approach (LTHA) group (<i>n</i> = 90) according to the surgical approach, and the clinical data, perioperative indices, and postoperative survival rates of the two groups were compared.</p> Results <p>The SLTEA group had shorter surgical time, first ambulation time after surgery, first postoperative intestinal peristalsis time, and postoperative hospital stay than the LTHA group (<i>P</i> &lt; 0.001). Besides, the SLTEA group had longer proximal esophageal cut edge length and a higher total number of lymph node dissections than the LTHA group (<i>P</i> &lt; 0.001). The K-M survival curve shows that the five-year overall survival rate of the SLTEA group is higher than that of the LTHA group (<i>P</i> = 0.0386).</p> Conclusion <p>For patients with Siewert type II AEG, the minimally invasive SLTEA is safe and effective, with shorter operative time, longer esophageal margins, more complete lymph node dissection, better postoperative recovery, and more benefits for patients’ long-term survival. It can be promoted as a complementary option to Siewert type II AEG surgery.</p>