Esophageal cancer is essentially a disease of the elderly. Several studies suggested that age per se should not be considered a risk factor for surgical mortality and morbidity, and access to surgical treatment should not be denied only on the basis of age. Indeed, advanced age may represent an indicator of several factors such as comorbidity or poor physical performance which in turn can increase surgical risk and dramatically reduce life expectancy. Therefore, a careful preoperative assessment of these factors, with particular regard to comorbid conditions (such as cardiovascular and pulmonary diseases), the physiological status, and social habits is necessary in elderly adults. In consideration of the need of a multidisciplinary assessment to identify comorbidities and operative risk, a close collaboration of pneumologists, cardiologists, radiologists, oncologists, thoracic surgeons, anesthesiologists, geriatric specialists, physical therapists is highly recommendable.