Curative surgical treatment of esophageal cancer involves the complete macroscopic and microscopic removal of the tumor (R0-resection), since this is the only means by which the prognosis can be improved. The treatment of choice for squamous cell cancer is transthoracic en bloc esophagectomy. Tumors penetrating the esophageal wall (T3/T4) above the tracheal bifurcation and T4 tumors below the bifurcation should be treated preoperatively by (radio)chemotherapy within the framework of a multimodal therapeutic approach.