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To study the clinical biocharacteristics of primary esophageal small-cell carcinoma (PESC) and factors influencing prognosis and to find rational indications for combination therapy. Methods: To analyze the clinical materials of 47 patients who had undergone an operation with PESC and to compare it with those patients with esophageal squamous-cell carcinoma (ESCC) or primary esophageal adenocarcinoma (PEAC). Results: The overall resectability, morbidity and 30-day mortality rates of PESC were 93.6%, 17.0%and 2.1% respectively, similar to those of ESCC or PEAC. TNM staging and lymph node metastasis were the major determinants influencing long-term survival. Tumor length, depth of tumor invasion and type of operation had little influence on long-term prognosis. The 5-year survival rate of PESC was 7.5%, which was much lower than that of ESCC and PEAC (P<0.01). Among the 42 deceased patents, one died of anastomotic leakage and the others died of remote metastasis and recurrence. Adjuvant chemotherapy did not help improve the patients’ long-term survival. Conclusions: Compared with ESCC and PEAC, PESC is the most malignant type with early lymphatic and hematogenous metastases and poor prognosis. Lymph node metastasis is the major factor influencing the prognosis. Patients in stage 0, I and II a of PESC are indicated for surgical resection, while those in stage II b, III or IV should be managed with non-surgical combined therapy.