Background: Optimal timing of postoperative enteral nutrition following esophagectomy remains controversial. This study aimed to evaluate the effectiveness of immediate postoperative enteral nutritional support on clinical outcomes in patients undergoing esophagectomy for esophageal carcinoma. Methods: A prospective randomized controlled trial was conducted involving 60 patients with esophageal carcinoma undergoing curative esophagectomy. Patients were randomized to receive either immediate enteral nutrition (IEN) within 24 hours after surgery (n=30) or delayed enteral nutrition (DEN) initiated on postoperative day 5 (n=30). The primary outcome was the incidence of postoperative infectious complications. Secondary outcomes included nutritional parameters, inflammatory markers, recovery milestones, and quality of life. Results: The IEN group demonstrated a significantly lower incidence of overall infectious complications compared to the DEN group (26.7% vs 56.7%, p=0.018). Pneumonia occurred less frequently in the IEN group (16.7% vs 40.0%, p=0.045). The IEN group showed improved nutritional parameters, including higher albumin levels on postoperative day 7 (3.2 ± 0.4 g/dL vs 2.9 ± 0.5 g/dL, p=0.011), reduced inflammatory markers (CRP: 82.4 ± 28.6 mg/L vs 128.7 ± 36.2 mg/L on postoperative day 5, p<0.001), faster recovery of gastrointestinal function (time to first flatus: 2.8 ± 0.9 days vs 3.7 ± 1.2 days, p=0.002), and shorter hospital stay (12.3 days vs 16.8 days, p=0.003). The rates of anastomotic leakage (6.7% vs 16.7%, p=0.228) and feeding intolerance (26.7% vs 20.0%, p=0.542) were similar between groups. Multivariate analysis identified immediate enteral nutrition as an independent protective factor against infectious complications (OR 0.38, p=0.014). Conclusion: Immediate postoperative enteral nutrition following esophagectomy significantly reduces infectious complications, improves nutritional status, attenuates inflammatory response, and shortens hospital stay without increasing anastomotic leakage or feeding intolerance. These findings support the routine implementation of immediate enteral nutrition after esophagectomy.