Esophagogastrectomy is the best available treatment for patients with carcinoma of the esophagus or cardia and is associated with low hospital morbidity and mortality. It provides better longevity than other types of therapy and an acceptable survival rate. After esophagogastrectomy, 80% or more of the patients have satisfactory palliation of dysphagia. During an 18-year experience (1970 to 1988) with surgical treatment of carcinoma of the esophagus or cardia at the Lahey Clinic, 82.3% of patients with this disease were surgical candidates. Of the 310 patients who were treated surgically, 275 (88.7%) underwent resection, and the 30-day mortality rate was 2.2%. In 196 patients, gastrointestinal continuity was reestablished afterward by intrathoracic esophagogastrostomy. Cervical anastomosis was performed in 61 patients, 53 of whom had transhiatal resection. Major complications that prolonged the hospital stay occurred in 40 patients, and minor complications occurred in 28. The adjusted actuarial 5-year survival rate was 20.8% for all patients and 23.3% when only curative resections were considered. Stage of the disease was the most important determinant of long-term survival. Survival statistics were similar for patients with squamous cell epithelioma, adenocarcinoma of the cardia, or adenocarcinoma in Barrett's esophagus.