This study compared extended transthoracic resection with limited transhiatal resection for adenocarcinoma of the esophagus or gastric cardia. The five-year survival rates in the two groups were not significantly different, but a nonsignificant trend in overall survival favored transthoracic resection in later years. In this study of resection for adenocarcinoma, a trend in survival favored transthoracic resection. Long-term survival after surgery with curative intent for adenocarcinoma of the distal esophagus and gastric cardia is only 20 percent. 1 , 2 Surgery is generally considered to offer the best chance for cure, but opinions differ on how to improve survival by surgery. One strategy aims at decreasing early postoperative risk by the use of limited cervicoabdominal (transhiatal) esophagectomy without formal lymphadenectomy. Another is intended to improve long-term survival by performing a combined cervicothoracoabdominal resection, with wide excision of the tumor and peritumoral tissues and extended lymph-node dissection in the posterior mediastinum and the upper abdomen (transthoracic esophagectomy with extended en . . .