Background The optimal treatment strategy for limited-stage small cell esophageal carcinoma (LS-SCEC) remains uncertain. This study aimed to retrospectively evaluate the efficacy of perioperative therapy in these patients. Materials and Methods Between June 2005 and November 2022, 156 patients with LS-SCEC who underwent esophagectomy were included in this study. The primary endpoint was overall survival (OS), and secondary endpoints included disease-free survival (DFS) and postoperative complications. Prognostic factors were analyzed using univariate and multivariate Cox regression models, as well as propensity score matching. Results Of the 156 patients, 33 (21.2%) patients received neoadjuvant chemotherapy, 76 (48.7%) underwent adjuvant chemotherapy, and 13 (8.3%) received adjuvant chemoradiotherapy. Post-surgery, 33 (21.2%) patients were classified as stage I, 40 (25.6%) as stage II, 61 (39.1%) as stage III, and 22 (14.1%) as stage IV. The median OS was 21.0 months, with 5-year OS and DFS rates of 25.9% and 21.9%, respectively. Multivariate analysis identified clinical T stage (P = .049), neural invasion (P = .002), N stage (P = .006), and adjuvant therapy (P = .001) as independent prognostic factors. Neoadjuvant chemotherapy significantly improved OS, with a 5-year OS rate of 37.7% compared to 0.0% in the non-neoadjuvant chemotherapy group (P < .001). Across the cohort, adjuvant therapy enhanced both OS and DFS. Conclusions Perioperative therapy is crucial for LS-SCEC management. Neoadjuvant chemotherapy improves OS in patients with LS-SCEC. Adjuvant chemotherapy is recommended almost for all patients with LS-SCEC.