Loco-regionally advanced esophageal cancer is a lethal disease with poor outcomes despite aggressive multimodality therapy.Surgical resection has been considered as the standard of care.The surgical mortality rate is highly correlated with the volume of the esophagectomies in the treating institutions.The goal of the surgical resection is to achieve R0 resection,because without R0 resection,patients have no chance to be cured.High local and distant recurrence rate are major patterns of treatment failure after surgery only.Neoadjuvant chemotherapy may improve patient overall survival compared with surgery only.Preoperative chemoradiotherapy may be superior to preoperative chemotherapy.