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Objective To investigate the influence of body mass index (BMI) on postoperative complications and longterm prognosis in patients with esophageal squamous cell carcinoma (ESCC). Methods A total of 1 479 patients with ESCC who underwent radical resection were included in this study. According to BMI, 100 patients were divided into the low BMI group (BMI＜18.5 kg/m²), 850 cases were divided into the normal BMI group (18.5 kg/m²≤BMI＜24 kg/m²) and 529 cases were divided into the high BMI group (BMI≥24 kg/m²). Postoperative complications of patients were compared between the three BMI groups. Kaplan-Meier survival curve was used to compare the overall survival of the three groups, and Cox proportional risk model was used to analyze the influence of BMI on prognosis of patients. Results Compared with the normal BMI group, the incidence of incision infection was increased in the high BMI group, and the incidence rates of pulmonary infection and arrhythmia were increased in the low BMI group (P＜0.05). Compared with the low BMI group, the incidence of arrhythmia was lower in the high BMI group (P＜0.05). There were no significant differences in the incidence of anastomotic leakage, respiratory failure, chylothorax and vocal cord paralysis between the three groups (P＞0.05). Kaplan- Meier survival curve showed that the 5-year cumulative overall survival rate of patients was significantly lower in the low BMI group than that in the normal BMI group (Log-rank χ²=16.857, P＜0.01) and the high BMI group (Log-rank χ²=18.802, P＜0.01), while there was no significant difference in 5-year cumulative overall survival rate between the high BMI group and the normal BMI group (Log-rank χ²=0.324, P=0.569). Multivariate Cox regression analysis showed that low BMI was an independent risk factor for the prognosis of patients with esophageal squamous cell carcinoma (HR=1.449, 95% CI: 1.084- 1.938, P＜0.05). Conclusion High BMI increases the incidence of incision infection after esophagectomy in patients with ESCC. Low BMI increases the incidence of pulmonary infections and arrhythmia, and is an independent predictor for poor overall survival. [ABSTRACT FROM AUTHOR]