Objective To explore the mediating role of symptom distress between family function and supportive care need among esophageal cancer patients after esophagectomy. Methods A total of 218 esophageal cancer patients after esophagectomy were selected using convenient sampling, then they were investigated utilizing the general information questionnaire, the Family APGAR Index (APGAR), the M.D. Anderson Symptom Inventory-Gastrointestinal Cancer Module (MDASI-GI) and the Supportive Care Needs Survey-34-item Short Form (SCNS-SF34).Structural equation model was established to test the relationship among the three variables. Results The family function score of the participants was (6.60±1.59) points, the score of symptom severity was (82.72±6.41) points, the score of symptom distress was (33.28±5.39) points.Each dimension score of supportive care needs:physical and daily living need was (61.58±8.04) points, psychological need was (55.47±6.93) points, sexuality need was 0.00(0.00, 24.99) points, patient care and support need was (48.20±7.99) points, health system and information need was (64.64±6.72) points.Patients′ family function score was negatively correlated with their symptom distress score and each subscale score of supportive care needs (except sexuality needs), and their symptom distress score was positively correlated with each subscale score of supportive care needs (except sexuality needs) (P＜0.01 for all).The mediating effect of symptom distress between family function and supportive care needs accounted for 43.60% of the total effect. Conclusion Symptom distress plays a mediating role between family function and supportive care needs among esophageal cancer patients after esophagectomy, and family function can influence symptom distress and supportive care needs.