Although curative resection of esophageal cancer has become a safe procedure, in patients with pulmonary dysfunction, postoperative complications remain a serious problem. Of 122 patients who had transthoracic resection of esophageal cancer, 27 had pulmonary dysfunction; in six, the forced vital capacity was less than 70% (minimum of 42.8%, mean +/- SD of 56.6 +/- 8.9%); in 18, forced expiratory volume for one second (FEV1%) was less than 70% (minimum of 34.6%, mean +/- SD of 60 +/- 10%); and in three, both forced vital capacity and forced expiratory volume was less than 70%. Two patients had undergone hemipneumonectomy before receiving resection of the esophagus. During the intrathoracic operative procedure, high frequency ventilation was used, providing good surgical exposure and contributing to a decrease of postoperative pulmonary complications. There were no deaths during the month after surgery. The survival curve of these patients was not significantly different from that of other patients who had had esophagectomy for cancer of the esophagus. These patients survived for an average of 24 months. The patient who survived the longest has been alive for more than 11 years.