Background <p>An appropriate rehabilitation program should follow thoracoscopic lung cancer radical surgery (TLCRS) to promote patient recovery during the perioperative period. However, enhanced recovery after surgery (ERAS) and conventional rehabilitation mode (CRM) programs remain a subject of debate to date. Therefore, in this randomized controlled trial, we compared the effectiveness and safety of an ERAS program with those of a CRM program after TLCRS in local regional hospitals.</p> Methods <p>From August 2021 to July 2022, in this double-blind randomized controlled trial, 80 patients who met the inclusion criteria were randomly divided into two groups at a 1:1 ratio: the ERAS program and the CRM program. The primary outcomes were the effectiveness and socioeconomic effects of the two kinds of programs. The secondary outcomes included&#xa0;the incidence of postoperative complications and the safety of the two kinds of programs.</p> Results <p>Compared with the CRM group, the ERAS group experienced notable benefits (<i>P</i> &lt; 0.001) in terms of length of hospital stay, postoperative length of hospital stay, time to thoracic drainage tube removal, time to postoperative oral feeding, time to postoperative ambulation, postoperative pain score, and hospitalization costs. Compared with the ERAS group, the CRM group experienced notable consequences such as postoperative atelectasis/pulmonary infections (<i>P</i> = 0.029) and prolonged operative times (<i>P</i> &lt; 0.001). The incidence of postoperative ICU admission in the ERAS group was significantly lower than that in the CRM group (<i>P</i> = 0.048); however, the ERAS group had a higher rate of postoperative chest tube replacement than the CRM group did (<i>P</i> = 0.025).</p> Conclusions <p>Compared with the CRM program, the ERAS program is associated with a lower incidence of postoperative pulmonary complications, faster recovery, less pain, and smaller economic burden, improving patients’ postoperative prognoses.</p>