Abstract: Objective To analysis the risk factors of lymph node metastasis (LNM) in superficial esophageal squamous cell carcinoma (SESCC). Methods The clinical data and pathological results of 344 SESCC patients, who underwent surgical treatments between January 2009 and December 2013 in West China Hospital, Sichuan University, were analyzed retrospectively. Clinicopathologic characteristics were compared between different histological types, and their possible relationships with LNM were explored by univariate and multivariate analysis. Results There were no LNM found in the patients with tumor limited to the mucous, tumor diameter ＜3 cm, highly and moderate differentiated SESCC. Univariate analysis showed that tumor diameter ( P=0.004)，depth of tumor invasion ( P=0.009)，histological type ( P=0.030) and lymphatic involvement ( P=0.002) were correlated with LNM. Multivariate analysis revealed that tumor diameter ( P=0.007)，depth of tumor invasion ( P=0.003)，histological type ( P=0.010)and lymphatic involvement ( P<0.001) were independent risk factors of LNM. Conclusion To the patients with low risk of LNM, such as tumor limited to the mucous, tumor diameter ＜3 cm, and highly and moderate differentiation, endoscopic excision may be considered as an absolute indications.