The prognosis for esophageal cancer remains poor because it is often diagnosed late and patients often have unfavourable backgrounds. This is reflected in standardised 5-year net survival rates of no more than 20%, regardless of gender. Unlike gastric cancer (CDH1 gene mutation), there is currently no genetic predisposition to esophageal cancer that would justify prophylactic esophagectomy. Primary prevention by identifying and managing modifiable risk factors is therefore the best strategy for preventing esophageal cancer. The role of surgery in the prevention of esophageal cancer is discussed in this review. Although recommended, the value of antireflux surgery (fundoplication) for Barrett's esophagus with the sole aim of reducing the risk of esophageal adenocarcinoma remains controversial. With regard to bariatric surgery, national cohort studies report an equivalent or reduced incidence of esophageal adenocarcinoma in operated patients compared with non-operated obese patients. However, given the significant increase in the number of bariatric procedures, further studies with longer follow-up are needed. In addition, although surgical myotomy is a truly effective therapeutic option for the treatment of achalasia in the first-line setting, its impact on the risk of esophageal cancer remains uncertain and poorly studied.