BACKGROUND: Surgical resection remains the main goal for patients with localized esophageal cancer. It is justified only when it can be achieved with low rates of morbidity and mortality. The best option in terms of surgical approach and resection’s completeness is the triple approach described by McKeown. METHODS: We performed an observational study on the patients operated for esophageal carcinoma using the triple approach from 2002 until 2012. Different data as demographic, clinical, operative and pathological data were recorded and statistically analyzed. RESULTS: We included 31 patients with a mean age of 62.5 years (range 39-76). The tumor site was in 26 cases (83.8%) to the middle esophagus and in 5 cases (16.2%) to the lower esophagus. Mean ICU stay was 7.9 days (range 4-25). Overall morbidity was 61.3%; 15 patients (48.4%) developed pulmonary complications. Most of the cases (80.6%, n=25) were considered as stage III at pathological exam. CONCLUSIONS: Triple approach of esophageal cancer is a technical demanding intervention that provides the best chance for oncological resection of esophageal cancer. Achieving low rates of morbidity and mortality depends of patients’ selection, the accuracy of operative technique and the multidisciplinary approach involving surgeon, anesthesiologist, nutritionist, oncolog and nursing support.