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In patients with esophageal carcinoma surgical resection remains the standard of curative treatment. For locally advanced tumors (pT1sm-pT3) transthoracic esophagectomy with extended lymphadenectomy is the standard surgical procedure since it offers a complete removal of the primary tumor and possible lymph node metastases. This surgical resection is appropriate for squamous cell but also adenocarcinoma of the esophagus because both histological entities demonstrate a lymphatic spread to the abdominal compartment and the upper mediastinum. In-hospital mortality rates are between 6% and 9%; anastomotic leakage and pulmonary complications mainly contribute to postoperative morbidity. In terms of 5-year survival the transthoracic procedure offers a better prognosis compared to the transhiatal resection.