We present the results we obtained during the last 12 years with transhiatal esophagectomy. Two hundred and eighty-three patients were operated on using this procedure; 171 of them underwent the operation for cancer of the esophagus, 73 for cancer of the cardia, and 11 for cancer of the hypopharynx. The tumor stage, the operative technique, and the type of esophageal replacement (stomach: 62.9%; colon: 37.1%) are described. Overall operative mortality was 5.6%, mainly as a result of respiratory insufficiency. Long-term survival was 11.9% at five years for cancer of the esophagus, much lower than the 48.3% for cancer of the cardia.