Objective To determine the effect of different nutritional supports on the clinical outcomes in elderly patients with esophageal cancer after operation.Methods A total of 90 elderly patients with esophageal cancer undergoing surgical treatment in the Department of Thoracic Surgery of Mianyang Central Hospital from November 2015 to August 2016 were enrolled in this study, and were randomly divided into 3 groups before surgery:enteral nutrition (EN) group, parenteral nutrition (PN) group and enteral nutrition combined with parenteral nutrition (EN+PN) group, with 30 cases in each group. All patients were given the corresponding nutritional supports within 24 h after operation.Clinical outcomes were evaluated with body weight loss, length of hospital stay, hospitalization costs, and incidence of pulmonary infection. SPSS statistics 19.0 was used to analyze the date. Student’s t test or Chi-square test was adopted to make the comparison between groups. Results Compared with the patients of EN group, the body mass loss was higher in those of the PN group [(7.3±1.3) vs (6.4±1.6)kg], but lower in those of the EN+PN group [(4.6±1.0) vs (6.4±1.6)kg, both P＜0.05]. The EN+PN group had notably shorter length of hospital stay and lower incidence of pulmonary infection than the EN and PN groups (P＜0.05), while there were no significant differences between the latter 2 groups (P＞0.05).The hospitalization cost was the highest in the PN group, followed by the EN+PN group and the EN group in turn, with obvious difference between mutual groups (P<0.05). Conclusion Early nutritional support with EN+PN is better than others in terms of improving clinical outcomes of the elderly patients with esophageal cancer after surgery.