The incidence of esophageal cancer in the advanced age has increased relatively in recent years, which is the result of the improvement of people’s living standard and the quiet arrival of the aging society. Generally, we call 60-70 years old as old age, 70-80 years old as senior age, and over 80 years old as super senior age. The elderly esophageal cancer patients have their special characteristics in physiological, psychological and social life, and the treatment of esophageal cancer also needs special discussion. In terms of esophageal cancer treatment plan for the elderly patients, strict distinction should be made and appropriate individual treatment plan should be formulated. As we all know, surgery has the outstanding advantages of being radical and non-biologically resistant. In recent years, the indications for surgery for high-aged esophageal cancer have been expanded much more than before. However, the expansion of surgical indications has led to a corresponding increase in postoperative complications. Surgical deaths within 30 days after surgery are mostly in this age group. The increase in surgical complications and surgical mortality is related to the heavy trauma of major open-heart surgery on the one hand, and to the poorer physical condition of elderly esophageal patients with a more complicated past medical history and often combined with multiple organ diseases on the other. The more common comorbidities include malnutrition, anemia and diabetes, cardiovascular and respiratory diseases, old thoracic and abdominal diseases and surgical experiences, potential subclinical hypofunctional state of multiple organs, long-term smoking and alcohol consumption, psychological and social family aspects can have serious postoperative effects. Even some seemingly common complications can become insurmountable obstacles in the lives of highly elderly patients. Common postoperative complications include pneumonia, including infectious and aspiration pneumonia, pulmonary atelectasis, pulmonary edema, respiratory failure, etc. In the cardiovascular area, there are various atrial or ventricular arrhythmias, hypertension, heart failure, myocardial infarction, pulmonary embolism due to deep vein embolism, etc. Other complications include anastomosis, wound edema, poor healing, severe infection, and multiple organ failure due to hypoproteinemia, diabetes, etc. etc. For patients with better general health condition, greater possibility and certainty of surgical resection, especially those who can be resected radically, they should make good preparation before surgery and strive for surgical treatment. Minimize the surgical blows and shorten the operation time during the operation of esophageal cancer. After esophageal cancer surgery, close monitoring, adequate nebulization, effective sputum excretion and encouragement of bedside activities should be carried out. Due to the lack of cardiopulmonary reserve function of senior elderly patients, cardiopulmonary complications are easy to occur after surgery, which must be dealt with timely. Some patients with esophageal cancer have difficulty in eating and poor nutritional status before admission due to prolonged esophageal obstruction. After admission, nasal feeding of high-calorie nutrition, such as soy milk and broth, is given to rapidly improve the physical condition and enhance the ability to tolerate surgery. This can avoid blood transfusion, plasma and protein transfusion after surgery, reduce the complications associated with prolonged and extensive postoperative parenteral nutrition, and also reduce the cost of treatment. For the surgery of middle and lower thoracic esophageal cancer in the elderly, we adopt a mechanical anastomosis of the stomach with the esophagus from behind and above the aortic arch by lifting the stomach over the esophageal bed, and the stomach resides in the mediastinal esophageal bed after the surgery, which avoids the common postoperative “thoraco-gastric syndrome” and reduces the loss of pulmonary function. This procedure is particularly suitable for patients with low cardiopulmonary function and ultra-advanced age. For some high-grade lesions, including cervical and upper thoracic esophageal cancer, based on the principle of ensuring radical treatment, a left upper cervical abdominal median esophageal extraction is used, which avoids open-heart operation and improves safety. Alternatively, a posterior-lateral incision through the right chest was adopted, the stomach was freed through the esophageal cleft, and the right chest was super-thoracic apex esophagogastric anastomosis, which avoided the more traumatic conventional three-incision surgery of the left neck, posterior-lateral right chest and superior mid-abdomen. Placing the stomach behind the sternum has much less impact on cardiopulmonary function than lifting the neck anastomosis through the esophageal bed. For residual gastroesophageal cancer with previous major gastrectomy, the residual stomach, spleen and tail of the pancreas can be pulled into the thoracic cavity and anastomosed under the esophagogastric arch, and if necessary, the colon can be used instead of the esophagus. For some medullary or ulcerated esophageal cancers with high and long lesions, which may invade the tracheal membrane or large blood vessels and have a large niche that will be perforated, half amount of radiotherapy can be given before surgery, which will improve the surgical resection rate and increase the safety of esophageal cancer surgery. Post-operative radiotherapy and chemotherapy for high-aged esophageal cancer should be taken with caution, and the necessity and effect of post-operative chemotherapy should not be overstated. Short courses of chemotherapy should be flexibly adopted according to patients’ physical and immunity recovery. For patients with lymph node metastasis or palliative surgery found by pathology after esophageal cancer surgery, appropriate radiotherapy can be adopted.