Purpose <p>This nationwide observational study investigated the recent trends and demographic patterns of esophageal cancer incidence and surgery in Japan.</p> Methods <p>The annual incidence data (2016–2021) and surgical procedure counts (2014–2023) were extracted from the Cancer Information Database and National Database of Health Insurance Claims and Specific Health Checkups. Surgeries were categorized by anatomical extent and surgical approach (open/thoracoscopic/mediastinoscopic), with minimally invasive procedures further categorized by robotic assistance. The crude and age-adjusted rates per 100,000 person-years were calculated. The temporal trends were evaluated using linear and Poisson regression models.</p> Results <p>The average annual incidence of esophageal cancer was 25,711 cases, and 5,896 surgeries were performed. While the cancer incidence remained stable, the surgical approaches have transformed significantly. A sharp decline was observed in traditional open surgeries (<i>P</i> &lt; 0.0001), while the number of minimally invasive surgeries increased substantially. This included significant growth in thoracoscopic (<i>P</i> &lt; 0.0001), mediastinoscopy (<i>P</i> = 0.0085), and robotic-assisted procedures (<i>P</i> = 0.0006), with annual risk ratios of 1.088, 1.185, and 1.440, respectively (all <i>P</i> &lt; 0.0001). This transition toward minimally invasive techniques was the most pronounced among older adults.</p> Conclusion <p>Esophageal cancer surgery in Japan is undergoing a major shift toward minimally invasive approaches, particularly in older patients.</p>