Esophageal carcinoma is one of serious cancers, with a wide range of gastrointestinal symptoms due to late diagnosis, older age, and nutritional deficiencies. This cancer is more common in males as compared to their counterparts and are reported in older age. A retrospective observational study was conducted at a tertiary care hospital in Rawalpindi, Pakistan, from July to December 2024 and included 379 patients of esophageal carcinoma. Patients with histopathologically confirmed esophageal carcinoma who underwent surgical management were included in the study. Staging was performed using contrast-enhanced computed tomography (CECT), and positron emission tomography (PET). Preoperative assessment of patients included spirometry, echocardiography, and multidisciplinary team evaluation. Data on demographics, clinical presentation, tumor characteristics, stage at diagnosis, treatment modalities, and postoperative outcomes were recorded by employing a standardized proforma. Patients were followed for 6 months to 2 years, and outcomes were analyzed using descriptive statistics. Results highlighted that majority of patients were aged from 50 to 69 years, with Stage III being most prevalent stage (50.6%). Chemotherapy was administered to 71.8% of patients, with 18.7% receiving preoperative chemotherapy and 26.1% took preoperative concurrent chemoradiotherapy (CCRT). Thoracophrenolaparotomy was common surgical procedure, performed in 29.2% of cases. Postoperative complications included anastomotic stricture (12.1%) and anastomotic leakage (8.1%). Respiratory complications, such as atelectasis (23.7%) and pneumonia/respiratory failure (1.3%), were reported among the cohort, with an overall mortality proportion of 5.8% (22 deaths). The follow-up data showed that 41.8% of the patients were followed up at one year and 40.2% at six months, with a decreasing follow-up frequency over time. This study concluded that despite treatment, including chemotherapy and surgery, complications like anastomotic stricture and respiratory failure were important postoperative concerns and were associated with an overall mortality proportion of 5.8%. Early diagnosis and effective postoperative care are crucial for improving patient outcomes.