Mortality rate after esophagectomy ranges from 2% to more than 25% and is related to preoperative and operative factors. Pulmonary complications are frequently seen after esophageal resection with a high mortality rate. The aim of preoperative pulmonary risk assessment is to identify patients who can undergo esophagectomy evaluating patient-related risk factors and their treatment. Preoperative pulmonary risk factors are smoking, respiratory diseases as COPD, elderly age and general condition. Careful medical history, physical examination and pulmonary function testing contribute to identify risk factors and strategies to reduce the risk of pulmonary complications.