Since 1982, Ivor Lewis esophagectomy has been performed on 264 patients with epidermoid esophageal carcinoma in our series. The mean age was 59. There were 243 men and 21 women; 91 patients had respiratory or cardiovascular problems. Two-hundred forty-eight tumors were located in the lower two thirds of the esophagus. Sixty-eight patients had preoperative radiochemotherapy with cisplatinum and 5-flourouracil. One half of the resected specimens showed no residual tumor after radiochemotherapy. Tumor infiltration was T3 or deeper in 162 specimens, and 142 were N0. The main complications were respiratory (16%) and leaks (7%). Respiratory insufficiency was always fatal, but only 16% of the leaks led to death. The overall postoperative mortality was 4.5%, and the overall 5-year survival is 33.3%. Only T1 tumors have a significantly better prognosis (53.2% 5-year survival) as compared to T2 (30.6%) and T3 (27.2%), both at 5-year survival. Negative lymph node patients have a significantly improved 5-year survival rate of 44.8% vs. 15.2% for nodepositive patients. For T3 tumors, preoperative radiochemotherapy seems to improve survival. Comparison of Ivor Lewis esophagectomy with other procedures shows no radical differences in complications. The 5-year survival rate seems unaffected by the procedure chosen; radiochemotherapy and extended lymphadenectomy still need further assessment.