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Objective: The role of surgical therapy in patients with locally advanced esophageal cancer is still controversially discussed. There is also controversy about whether neoadjuvant chemo or radio-chemotherapy should be the standard management in patients with locally advanced esophageal carcinoma. Furthermore, many gastroenterologists and oncologists believe that surgery should be avoided in locally advanced esophageal cancer due to high mortality and morbidity rates related to the procedure and the very low benefit for the patient. Material and Methods: Retrospective analysis of prospectively collected data of 256 patients with locally advanced esophageal cancer (220 patients with pT3 and 36 patients with pT4) that were not neoadjuvantly treated and had surgical resection with curative intend. One-hundred-sixty-one patients underwent extensive Ivor-Lewis thoraco-abdominal esophagectomy (TAE) whereas 95 had limited transhiatal (TH) resection. Locally advanced esophageal cancer was defined, based on the final histological report of the resection specimen, as a tumor infiltrating the paraesophageal tissue or the adjacent structures, without respect of the lymph node affection, the distant metastases or the histological grading.Results: Complete resection (R0) was achieved in 74.5% of patients that underwent TA esophagectomy and in 61.1% of the patients with TH resection (p=0.016). The median lymph node yield in TAE was significantly higher (25 lymph nodes, range 2-89) than in patients operated TH (14 LN, range 2-100; p=0.008), although no benefit for overall survival was found for patients with radical lymphadenectomy (lymph node yield of 19 or more - median 9 months vs. lymph node yield of 18 or less - median 10.8 months; p=0.480). Patients with locally advanced esophageal cancer but without evidence of tumor rest disease (pT3 & pM0 & R0, irrespective of the lymph node status) had similar overall survival (median 23.7 months, 5-Y of 22.4%) as pT2 without evidence of tumor rest disease (median 33 months, 5-Y of 27%; p=0.152). The operative method had significant influence on the disease free survival (TAE-median 12.1 months, 5-Y 22.9%; or TH - median 10 months, 5-Y 8.9%; p=0.049, data not shown).Discussion: Our results in the treatment of the patients with locally advanced esophageal carcinoma (median 13.7 months, 5-Y of 14.4%) are comparable to the results of the patients neoadjuvantly treated with chemoradiotherapy (median 10 to 14 months; 5-Y of 19-23%).