Abstract： Objective To explore the safety of video-assisted thoracoscopic esophagectomy for esophageal carcinoma.Methods From January 2005 to March 2012,260 patients with esophageal carcinoma received thoracoscopic esophagectomy(TE group),while 322 patients underwent conventional open esophagectomy (OE group).Operative procedures,perioperative complications,reoperation,readmission to intensive care unit (ICU),and perioperative mortality were compared between the two groups.Results Compared with OE group,TE group possessed less thoracic operative time[ (105±30)min vs.( 112±41 ) min,P=0.000],less blood loss[(95±48) ml vs.(107±44) ml,P=0.002],shorter postoperative hospital stay [(14.3±7.5) d vs.(16.9±9.5) d,P=0.000]and more lymph node harvest from thorax[(13.5±5.0) vs.(11.6±4.7),P=0.000].The total perioperative complication rate was lower in TE group than that of OE group (34.6％ vs.45.0％,P=0.011),as well as perioperative mortality (0.8％ vs.3.4％,P=0.032).Lower rate of readmission to ICU (5.4％ vs.10.6％,P=0.024) was found in the TE group as compared to the OE group,while the reoperation rate was comparable (1.5％ vs.2.5％,P=0.425).Conclusion Thoracoscopic esophagectomy is advantageous than open procedure in terms of surgical safety.