Intro: Surgical resection offers the highest survival rate for patients with esophageal cancer. However, esophagectomy is associated with high morbidity and mortality rates. The risk of aspiration and subsequent pneumonia is as high as 30% in recent large esophagectomy series and is associated with up to 20% mortality. Methods: A four-point, multidisciplinary, hospital-wide strategy of pre-emptive aspiration precautions is practiced at our institution which includes: preoperative instructions to the patient and family that the patient is not to lie flat post-operatively for any reason (including radiology studies such as CT scans), a “HOB up 90 degrees at all times” sign over patients hospital ICU and floor bed, timely removal of the NG tube on POD #2, and fluorocoscopic swallow evaluation with esophogram performed by otolaryngology speech/swallow service in conjunction with radiology on POD #5-7. A retrospective review of prospectively collected data was conducted on all esophagectomies performed 7/15/02-11/15/04. Results: Sixty-two esophagectomies were performed with 0% perioperative mortality and a medium length of stay of 9 days. The incidence of major complications was 33.9% including anastomotic leak 14.5%, reintubation 4.8%, chylothorax 4.8% PE 3.2% and pneumonia 3.2%. Conclusions: A hospital wide, multidisciplinary strategy directed at implementing preemptive aspiration precautions and careful post-operative swallowing assessment by specialized swallowing service results in a low incidence of pneumonia and mortality among patients after esophagectomy.