ObjectiveTo analyze the main causes and management of respiratory failure after surgery for esophageal cancer. MethodsWe retrospectively collected and analyzed the clinical data of 27 patients with respiratory failure after surgery for esophageal cancer in our hospital between January 2005 and December 2012. ResultsOf the 27 patients with respiratory failure after surgery for esophageal cancer, 23 were at advanced age, and 15 had moderately to severely impaired pulmonary function before surgery. After surgery, 19 suffered severe pulmonary infection, 8 yielded complications such as anastomotic leak, gastropleural fistula chylothorax, and postoperative bleeding. ConclusionPulmonary infections and surgical complications are the major and direct causes of respiratory failure after surgery for esophageal cancer. For high-risk patients at advanced age with impaired pulmonary function, enhancing perioperative airway management and improving surgical operation can decrease incidence of respiratory failure effectively.