Esophageal cancer is more than ever a surgical problem. Modern diagnostic procedures facilitate individual staging, and risk analysis is important for adequate patient selection. Using both allows an individualized indication. Under multimodal therapeutic protocols, neoadjuvant treatment can best be evaluated and is recommended in locally advanced tumors: RCTx in SCC, and CTx in Barrett cancer. Here the Ivor-Lewis procedure is the surgical method of choice. Postoperative complications are always possible, but the management now is standardized and has largely decreased mortality.