Esophagectomy is commonly performed for cancer of the esophagus and gastric cardia. The surgical approach to esophagectomy depends on several factors: anatomic location of tumor; preferred method of reconstruction: transposed stomach, interposed colon, pedicled jejunum; and location of the esophageal-enteric anastomosis. Conventional esophagectomy requires either a laparotomy with a trans-hiatal dissection or laparotomy combined with thoracotomy. A trans-hiatal approach is the most commonly performed operation for esophageal cancer resection. Evidence of chronic pulmonary disease, the ability to stand one-lung anesthesia and the likelihood of post-operative pulmonary complications may be predicted with the aid of the lung function test and cardiopulmonary exercise testing. The spectrum of gastro-esophageal reflux disease (GERD) involves the gastrointestinal and pulmonary organ systems. There is an association between GERD and end-stage lung disease, especially idiopathic pulmonary fibrosis (IPF). The presence of GERD may predispose to the development of bronchiolitis obliterans following lung transplantation.