Whereas the incidence of squamous cell carcinoma of the esophagus is slightly decreasing, adenocarcinoma shows a strong increase. Currently, the rate of pT1 tumors of both entities in specialized centers is in a range of 10-20% of all resected esophageal carcinomas. 15-25% of the pT1 cancers show multifocal lesions and 20-30% already have lymph node metastasis. Lymphatic involvement nearly exclusively develops in case of submucosal infiltration, whereas mucosal carcinomas mostly have no lymphatic spread. The standard surgical procedure for early esophageal cancer is subtotal esophagectomy and lymphadenectomy, in squamous cell carcinoma by right transthoracic approach as an en bloc esophagectomy, in distal adenocarcinoma via an abdominocervical approach as a transhiatal blunt dissection. Only in unifocal carcinomas limited to the mucosa is endoscopic mucosectomy an appropriate procedure according to preliminary results for squamous cell carcinoma. However, the preoperative endoscopic/endosonographic differentiation between mucosal or submucosal infiltration is difficult. After esophagectomy for early cancer the prognosis of patients with adenocarcinoma is significantly better than of those with squamous cell carcinoma (5-year survival rate: 83 vs. 61%).