Background <p>Type 2 diabetes mellitus (T2DM) is a well-recognized risk factor for various chronic and acute conditions. The primary aim of this study was to investigate the influence of T2DM on medical complications and long-term survival following minimally invasive esophagectomy (MIE).</p> Methods <p>A total of 906 consecutive patients with esophageal squamous cell carcinoma (ESCC) who underwent MIE were included in this retrospective study. Patients were categorized into two groups based on preoperative comorbidity with T2DM. Propensity score matching was utilized to align baseline information between the two groups.</p> Results <p>After PSM, 324 patients in the without-T2DM group (No-T2DM) and 118 patients in the Coexisting-T2DM group (Coe-T2DM) were ultimately included in the study. Compared with the No-T2DM group, the Coe-T2DM group exhibited longer total operative duration (225 vs 215; <i>P</i> = 0.039), more intraoperative blood loss (100 vs 60; <i>P</i> = 0.001), higher incidence of postoperative complications (56.78 vs 39.20%, <i>P</i> &lt; .001), and more severe complication (29.66 vs 17.28%, <i>P</i> &lt; .001). Furthermore, the Coe-T2DM group exhibited poorer long-term survival. The Cox multivariate analysis revealed that T2DM was an independent risk factor that influenced RRFS, DMFS, DFS, and OS.</p> Conclusion <p>T2DM may increase the incidence and severity of postoperative complications and adversely affects the long-term survival after MIE for patients with ESCC. T2DM patients undergoing metformin-free therapy and exhibiting poor glycemic control may potentially indicate a worse prognosis.</p> Trial registration <p>National clinical trials registry: NCT06333665, registered March 21, 2024.</p> Graphical abstract <p></p>