Elective esophagogastrectomy and reconstruction by esophagogastrostomy were performed on 55 patients with malignant tumors of the midesophagus, despite invasion of contiguous structures in 60% and regional lymph node involvement in 75%. The operations were invariably palliative. Two patients died within thirty days of operation. Dysphagia was relieved and oral alimentation resumed in the other 53. Twenty-nine patients who had experienced painful swallowing and 16 who had vomiting obtained relief. Survival curves show no improvement from previous decades for patients with malignancies of the middle third of the esophagus. The mean survival was 10.4 months. Mean survival of patients with liver metastases was 3.5 months.