This study is concerned with a western series of 521 squamous cell carcinomas of the thoracic esophagus treated over a recent 9-year period. Six points of the preoperative work-up are discussed: (1) total endoscopy; (2) respiratory function; (3) hepatic function as most of the patients were heavy smokers and alcoholic; (4) nutritional status; (5) CT scan, and (6) ultrasonography in order to assess the value of preoperative renutrition and the true correlation between surgical findings and CT scan and ultrasonography. When no curative resection can be performed, the discussion is centered on the effectiveness of chemotherapy and of palliative surgery. As far as curative resection is concerned, the indications of cervical and intrathoracic anastomoses and ‘en bloc’ posterior mediastinectomy versus blunt dissection are discussed. The mortality rate in this series of 235 curative resections was 6.4% due to pulmonary infection and fistulas. The late results are studied according to the Japanese classification. The overall 5-year actuarial survival is 19% and 30% for the group of curative resection in stages 0, I and II.