Objective To compare the results and safety between video-assisted thoracoscopic surgery ( VATS ) and conventional radical operation in patients with stage Ⅰ , Ⅱ esophageal cancer. Methods Retrospectively reviewed 43 patients with stage Ⅰ , Ⅱ esophageal cancer,underwent either VATS radical operation (VATS group,16 cases) or conventional radical operation (control group,27 cases ) from September 2007 to September 2009. Patient's operative characteristics and postoperative courses were compared between two groups. Results In VATS group the operation time was ( 115.6 ± 48.0) min,the peri-operative blood loss was ( 131 ± 71 ) ml,the first postoperative day chest lead quantity was (331 ± 170)ml, the time of postoperative chest tube was (7.25 ± 2.35) d,the postoperative 36 h visual analogue scale (VAS) was (3.4 ± 1.2) scores,the postoperative drainage of chest was ( 1281 ± 534) ml,the 72 h postoperative locomotor activity of right upper extremity was (5.1 ± 1.5) cm. While in control group was ( 145.6 ± 20.6)min, (292 ± 111 ) ml, (494 ± 194) ml, ( 10.00 ± 2.79 )d, (7.3 ± 1.4) scores, ( 1780 ± 731 ) ml, ( 15.6 ± 3.1 )cm respectively (P ＜ 0.01 or ＜ 0.05 ). The lymph node dissection number,the total cost of hospital between were no statistically significant differences in two groups (P ＞0.05). Conclusion Comparing with conventional radical operation, VATS radical operation for patients with stage Ⅰ , Ⅱ esophageal cancer appears to be as effective but less morbid.