Abstract: Esophagectomy is an effective treatment for esophageal cancer, and there has been growing attention on the importance of postoperative pain management in patients undergoing the surgery. Epidural analgesia is the preferred analgesic approach for open esophagectomy. With the development of surgical technology, minimally invasive esophagectomy (MIE) has become the mainstream surgical approach. However, no conclusion has been reached concerning whether epidural analgesia is still the preferred analgesic approach for MIE. Herein, we analyzed the relevant literature published in recent years and found that epidural analgesia continued to be an important analgesic approach for MIE, offering the best analgesic effect. Epidural analgesia can reduce postoperative pulmonary complications, improve the quality of life, and reduce the stress response. Adverse effects can be minimized through accurate selection of epidural puncture segments, individualized medication, and multimodal analgesia strategies. In the future, precision-based multimodal analgesia can be achieved using emerging technologies such as big data analytics and artificial intelligence.