<p>The trend of aging among patients with esophageal cancer is expected to continue in the future. We herein review the current status and future perspectives of surgical strategies for elderly patients with esophageal cancer. According to published systematic reviews and/or meta-analyses evaluating surgical risks in elderly patients with esophageal cancer, the outcomes of elderly patients were worse in terms of postoperative mortality, overall complications, pulmonary complications, cardiac complications, and the overall survival than those of non-elderly patients. In recent years, minimally invasive surgery for esophageal cancer has rapidly gained worldwide popularity. There is a need to reassess whether or not minimally invasive esophagectomy alters surgical indications and treatment outcomes in elderly patients with esophageal cancer. Optimizing perioperative treatment and management is also expected to promote advances in multidisciplinary treatment, including surgery, for elderly patients. Clinical studies focusing on elderly patients, along with biomarker research aimed at personalizing multidisciplinary treatment, are expected to contribute to further improvements in the treatment outcomes of elderly patients with esophageal cancer.</p>