Malnourished cancer patients undergoing major surgical treatments are at a high risk of morbidity and mortality. As compared to patients affected by other tumors, the highest rate of malnutrition (78.9%) was found in those with esophageal cancer due to postoperative complications. The impact of perioperative nutritional support on outcome in esophageal cancer patients undergoing surgery is analyzed. Strategies that can be used to preserve or restore the nutritional condition in patients throughout treatment are illustrated. Oral supplementation, and enteral or parenteral nutrition are among several methods of support. Enteral option is to be preferred because the intestinal integrity is preserved, the risk of complications is reduced and costs are lower. Prevention or correction of nutrient depletion in severely malnourished esophageal cancer patients remarkably reduces or eliminates malnutrition-related morbidity and mortality. Therefore to identify and treat malnutrition is of the utmost importance.