Esophageal cancer is an aggressive malignancy with an unfavorable prognosis and an increasing incidence worldwide.1 Locally advanced esophageal carcinoma might eventually be complicated by esophagorespiratory fistula, which is predominantly palliated by endoscopic stent placement. A subgroup of these patients present with direct tumor invasion of the adjacent pulmonary tissue, resulting in esophagopulmonary fistula and subsequent pulmonary abscess formation.2 Despite stent placement, the prognosis of esophagopulmonary fistula is grim. Most of these patients suffer from persistent pulmonary abscess formation leading to deterioration in their clinical condition and a fatal outcome within a short time.2,3 Therefore, the therapy of patients with esophagopulmonary fistulas should be focused on pulmonary abscess formation, which requires a different approach than that used for patients with uncomplicated esophagorespiratory fistulas. Surgical treatment with resection of the esophageal lesion and the involved pulmonary lobe might be a more promising option than conventional stent placement because this strategy enables the removal of all inflammatory tissue and might significantly prolong the survival time of these patients.4–6 Despite the potential benefits, it seems that most surgeons are rather reluctant to perform major surgery in these patients, who generally present in poor health.7 To our knowledge, there are no current reports addressing the issue of surgery for esophagopulmonary fistulas, apparently reflecting the widespread nihilistic attitude towards this life-threatening condition. Not only is the incidence of esophageal cancer constantly rising, but neoadjuvant radio-chemotherapy protocols are also being used more frequently, and these have been previously associated with the formation of esophageal fistulas.8 Consequently, the number of patients presenting with intractable esophagopulmonary fistulas is likely to increase, challenging the treatment modalities available. In our view, this problem is not adequately reflected in the current literature. Therefore, we report our experience with the surgical treatment of two consecutive patients presenting with malignant esophagopulmonary fistulas, who underwent simultaneous esophageal and pulmonary resection.