Objectives To investigate the effect of preoperative oral immunonutrition in the recovery of patients with esophageal cancer with nutritional risk. Methods A total of 80 cases of esophageal cancer patients treated in our hospital from March 2014 to March 2017 were divided randomly into the experimental group or the control group. The clinical data were compared between the two groups. Results No difference were observed between the two groups with respect to general data, surgical methods, pTNM staging data, complication rate, albumin and prealbumin indexes 7 days after surgery（P>0.05）. However, compared with control group, a significant decrease occurred in albumin, prealbumin, lymphocyte counts before and 1 day after surgery and lymphocyte counts 7 days after surgery and the incidence of intestinal adverse reactions, anal exhaust time, hospitalization day, hospitalization expense in the experimental group（P<0.05）. Conclusions Preoperative oral immunonutrition can improve the perioperative nutritional status of patients with esophageal cancer with nutritional risk and promote early postoperative recovery. It can be used as a preoperative support for these patients.