Introduction: An aging population and a rising incidence of esophageal adenocarcinoma have resulted in more elderly patients being evaluated for esophagectomy. This procedure is associated with significant morbidity and mortality and advanced age is often considered a relative contraindication. Our purpose was to compare clinicopathologic characteristics and outcome of esophagectomy in patients 75 years and older with younger patients. Methods: Records of 420 consecutive patients who had esophagectomy from 1992 to 2005 were reviewed. The extent of operation (en-bloc, transhiatal, staged reconstruction) performed was selected based on age and comorbid conditions. Clinical characteristics, demographic information and outcome were recorded. These were compared between patients < 75 years (n=344) and those ≥ 75 years (n=76). Results: Demographic information and symptoms at presentation were similar in the 2 groups. Comorbid conditions of hypertension and cardiac disease were more common in the older group. Neoadjuvant therapy was given more common in younger patients. Cardiac complications and deep vein thrombosis were more common in the older group. Length of ICU stay was longer in the older group, however the length of hospital stay was similar in both groups. (Table). Conclusion: Esophagectomy can be performed safely in elderly patients if the extent of operation is modified based on comorbid conditions. Elderly patients are more likely to have cardiac and vascular complications and require intensive perioperative support, but mortality and hospital stay are not different.