Esophagogastrectomy performed through an upper midline abdominal incision and a right lateral thoracotomy incision (Ivor Lewis esophagectomy) is used primarily to resect malignant neoplasms of the intrathoracic esophagus. Adenocarcinomas arising in the middle and distal portion of the esophagus, generally from Barrett’s mucosa, and squamous cell carcinomas of the middle and distal third of the esophagus are the usual indications. Before performing this procedure, patients with malig­nancies are usually staged with barium studies, endoscopy, endoscopic ultrasonography, and CT scans of the abdomen and chest. A wide spectrum of patients is eligible for this procedure including patients with advanced disease, patients with high-grade Barrett’s dysplasia, early-stage disease, and cancer downstaged with induction therapy. If there are widespread liver metastases, ascites, or other evidence of extensive spread, other means of palliation for the dysphagia should be con­sidered. The operative procedure can also be performed for benign strictures of the distal esophagus. Generally, howev­er, when the esophageal pathology is benign, colon, instead of stomach, is used for replacement. Also, when an acute perforation through a diseased distal esophagus is recognized immediately, this operative procedure can be considered.