Abstract: The current recommendation for postoperative radiotherapy for esophageal cancer in China is mainly based on the data of incomplete two-field dissection of open left thoracotomy. At present, the type of surgery for esophageal cancer gradually transitions from open left thoracotomy to open right thoracotomy and from open esophagectomy to minimally invasive esophagectomy (MIE). Patients with early-stage esophageal cancer are selected as candidates for MIE. MIE is less invasive than open esophagectomy, and the right thoracic approach is conducive to more thorough lymph node dissection. However, few data and related studies are available on the patterns of failure after MIE in esophageal cancer, and guiding an adjuvant therapy is difficult. The feasibility of an adjuvant therapy for selective high-risk patients and the optimized treatment after MIE remains to be explored in clinical practice. In this regard, this article aims to review the safety of MIE, long-term survival outcomes, postoperative recurrence patterns, and recurrence rates of patients to discuss the value of postoperative adjuvant therapy and guide clinical treatment.