Esophagectomy remains a key component of treatment for esophageal cancer and is also required in certain benign conditions. The functional sequelae of esophageal resection and reconstruction have taken on increasing importance due to the impact on long-term patient quality of life. Surgeons should be committed to a meticulous approach to conduit construction, avoid anastomoses in the mid and lower chest, and should also commit to careful long-term functional follow-up in their postesophagectomy patient population. Operative strategies to minimize functional disorders have been developed and all surgeons should have a structured approach to dealing with functional issues when they occur.