The pathophysiologic mechanisms that lead to pulmonary infection after esophageal cancer surgery include alveolar collapse, pulmonary edema, weakened pulmonary defense mechanisms, and poor ventilation. Perioperative risk factors associated with postoperative pulmonary infection include the existence of pulmonary inflammation and suboptimal control of infection before surgery for patients with chronic bronchitis, chronic cardiac insufficiency, age [≥80 years ], a long disease course, obesity, smoking, excessive drinking, diabetes, malnutrition , chronic obstructive pulmonary disease (COPD), preoperative chemotherapy , intraoperative use of single lung ventilation, and large intraoperative blood loss . In order to reduce postoperative pulmonary complications during esophageal cancer surgery, protective strategies should include an accurate assessment of the patient’s preoperative pulmonary function ; a good understanding of the effect of applying respiratory irritant drugs during anesthesia and the effects of anesthesia on the respiratory tract; attention to reduce physical damage to lung tissue while using double-lumen tracheal intubation; and the application of active measures after surgery, such as, prophylactic antibiotics, pulmonary toilet and nutritional support. Recurrent laryngeal nerve (RLN) injury continues to play a critical role in the development of postoperative pulmonary infection during cervical and upper thoracic esophageal carcinoma resection, with an incidence rate of approximately 1.2–15.0% . This review paper will address important aspects of diagnosis, prevention and treatment of postoperative pulmonary infections in esophageal cancer patients.