Objective To evaluate the status of subglottic secretion retention in elderly patients with tracheal intubation following esophageal cancer surgery and analyze its influencing factors. Methods A retrospective study was conducted on 120 patients with endotracheal intubation undergoing surgery for esophageal cancer in our department from April 2022 to December 2023. According to having subglottic secretion retention or not, they were divided into a retention group (75 patients) and a non-retention group (45 patients). The general information and perioperative data were collected to analyze the relative factors with logistic stepwise regression analysis. SPSS statistics 27.0 was used for statistical analysis. Data comparison between two groups was performed using t test orχ² test depending on data type. Results The retention group had significantly advanced age, larger ratio of smoking history, longer operation time and duration of tracheal intubation, more patients having gastric tube indwelling, and larger numbers of experiencing recurrent laryngeal nerve injury and gastroesophageal reflux when compared with the non-retention group (P<0.05). Regression analysis showed that advanced age (OR=2.380,95%CI 1.076-5.264), smoking history (OR=2.323,95%CI 1.040-5.189), preoperative indwelling gastric tube (OR=3.040,95%CI 1.543-5.990), and gastroesophageal reflux (OR=2.732,95%CI 1.247-5.983) were independent risk factors for subglottic secretion retention in the elderly patients with endotracheal intubation (P<0.05). Conclusion For the elderly patients with tracheal intubation after surgery for esophageal cancer, they are at a risk of subglottic secretion retention. Smoking, advanced age and digestive diseases are high-risk factors. Thus, timely intervention measures should be taken for the high-risk patients after comprehensive clinical evaluation.