In the Central Hospital of Central Finland (responsibility for 250,000 inhabitants) the technique of transmediastinal esophagectomy and colon interposition without thoracotomy was used on 19 consecutive patients in the years 1983-1988. Fourteen of the patients had a malignant and five a benign disease. The type of cancer was squamous cell cancer in 13, and adenocancer in 1 case. All five patients with a benign disease had an etiology of corrosion by various agents. Two of them had a spontaneous rupture. In three cases the perforation occurred as a complication of endoscopic dilatation. There were no peroperative but one postoperative death. Six minor complications were well under control. The survival rate of cancer patients is comparable with the results reported by other authors. All five patients with a benign disease are in excellent condition with a follow up time from 4 to 100 months (mean 44 mo).