Objective To construct a preoperative nutritional screening and evaluation index system for esophageal cancer patients and apply it initially to provide references for clinical medical personnel to identify the nutritional risk of patients. Method The preliminary version of the preoperative nutritional screening and evaluation index system for esophageal cancer patients was formed through evidence-based search and group discussion then the indexes were improved by two rounds of expert consultation method and the final version was constructed. A total of 120 preoperative patients with esophageal cancer who were treated at the Affiliated Tumor Hospital of Nantong University from September 2023 to May 2024 were selected as the research subjects. They were divided into an intervention group and a control group with 50 cases in each group according to the random number table method. The control group implemented conventional nursing care and the intervention group implemented the preoperative nutritional screening and evaluation index system of esophageal cancer patients based on the control group and compared the nutritional status of the patients in the two groups after the intervention. Result The preoperative nutritional screening and evaluation index system for esophageal cancer patients contains 5 primary indicators and 39 secondary indicators and the results of expert correspondence are better the preliminary application shows that the implementation of the preoperative nutritional screening and evaluation index system for patients can effectively improve the nutritional status of the patients P<0. 05 . Conclusion The preoperative nutritional screening and evaluation index system for esophageal cancer patients has good scientific validity and effectiveness in predicting patient nutritional risks.