The incidence of esophageal cancer in Hebei Province in China is the highest in the world. Our experience in the Department of Thoracic Surgery, Fourth Hospital, Hebei Medical University with the management of postoperative complications following esophagectomy was determined. From September 1952 to December 2005, a total of 20,796 patients underwent an intended esophagectomy for cancer in our department. Data for the outcome of these procedures was sourced from reported articles in the Chinese-language literature. The data were collated to determine the incidence and outcomes of postoperative complications. The incidence of major complications declined over the period of study. The likelihood of anastomotic leakage decreased from 5.0% to 2.3%, and pulmonary complications declined from 3.2% to 1.6%. The surgical mortality rate decreased from 17.1% to 0.6%. The incidence of postoperative complications and deaths following esophagectomy for cancer in our unit has fallen steadily over the past five decades. Improvements in preoperative preparation and postoperative management have contributed to this decrease.