Aim of this prospective study was to compare perioperative and oncologic outcome of patients submitted to open transthoracic esophagectomy (TTE) with either laparoscopic (LG) (Group A) or open mobilization of the stomach (OG) (Group B).Minimally invasive (MI) surgery has acquired increasing role in the treatment of cancer of the esophagus. In our institution LG combined to TTE with extended mediastinal lymphadenectomy, has been our preferred MI approach for cancer of the esophagus. In the period maj-2001 jul-2008, 168 patients (M 133) were included in this study (91 group A - 77 to group B). Assignement to either group based on the personal choice of the surgeon. The groups were similar for mean age, BMI, tumor site and histology, and neoadjuvant therapy. In group A there were more female.In group A, there were 6 conversions to open surgery (7,1%) and two intraoperative complications (1 splenic and 1 vascular lesion). In group B there were 7 major intraoperative abdominal complications (5 splenic and 2 vascular lesions). Mean total surgical duration was similar (257 vs 235 min). Overall morbidity rate was similar. Anastomotic and respiratory complications were similar (p=n.s.). Mortality was 1.2% in Group A and 2.6% in Group B. Late anastomotic complications were similar in the 2 groups (11,7% vs 10%). In group A two patients had to be reoperated on for a massive hiatal hernia; one patient in group B was reoperated on for bowel obstruction due to adhesion. Three and 5 year actuarial survival rate was similar (58 vs 47%).The laparoscopic approach for LG during esophagectomy reduces intraoperative major complications. Anastomotic complications are similar. Respiratory morbidity is not influenced by laparoscopic approach. Acute late major complications may be influenced by the surgical approach. Oncologic outcome is unrelated to the MI part of the procedure.