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Objective: Thoracoscopic esophagectomy (TSE), as a minimally invasive technique, has obtained wide acceptance for treating esophageal cancer. In this study, we report our experience of the transfer from open sweet esophagectomy (OSE) to TSE and compare cost associated with the two approaches for esophageal cancer.Patients and Methods: Data were taken through a retrospective review of operative outcomes, complications and cost of 91 patients who underwent OSE or TSE for esophageal cancer from January 2012 to June 2014.Results: Among 91 patients, 48 patients underwent TSE, and 43 patients underwent OSE. Patients dealt with TSE had significantly less blood loss (152 ml vs. 204 ml, P = 0.004), shorter chest drainage time (3.3 days vs. 4.5 days, P < 0.001), less patients admitted to the Intensive Care Unit after surgery (6.3% vs. 30.2%, P = 0.003), and lower incidence of respiratory complications (16.7% vs. 37.2%, P = 0.026). However, the operative time was statistically longer in TSE group (276.0 min vs. 207.4 min, P < 0.001). The total cost (¥61,817 vs. ¥48,712, P < 0.001) and the day of surgery cost (¥29,701 vs. ¥19,446, P < 0.001) were significantly higher in the TSE group.Conclusion: This study shows that TSE is a safe and acceptable alternative to OSE. TSE will be more competitive if its cost can be reduced. [ABSTRACT FROM AUTHOR]