A randomized trial compared multimodal therapy (chemotherapy, radiotherapy, and surgery) with surgery alone for esophageal adenocarcinoma. The study included 58 patients in the multimodal group and 55 in the surgery group. At the time of surgery, 42% of the multimodal group had positive nodes or metastases, compared to 82% in the surgery group (P<0.001). Thirteen of 52 patients in the multimodal group had complete pathological responses. The median survival was 16 months for the multimodal group versus 11 months for the surgery group (P=0.01). At one, two, and three years, 52%, 37%, and 32% of the multimodal group were alive, compared to 44%, 26%, and 6% in the surgery group (P=0.01). The survival advantage of multimodal therapy reached significance at three years. The study found that multimodal therapy was superior to surgery alone for resectable esophageal adenocarcinoma. The trial showed that preoperative chemotherapy and radiotherapy reduced the incidence of micrometastases, increased resectability, controlled systemic disease, and allowed accurate assessment of the pathological response. These factors may influence postoperative treatment decisions. The chemoradiotherapy regimen was well tolerated, with few toxic reactions. The study concluded that multimodal therapy followed by surgery provides a significant survival advantage over surgery alone at three years for patients with adenocarcinoma of the esophagus. The results support the findings of nonrandomized studies that have shown a complete pathological response in approximately 20% of patients treated with multimodal therapy. The study also highlights the importance of identifying patients who may benefit from surgery after preoperative treatment. The results suggest that multimodal therapy should be considered in all patients with tumor confined to the esophagus and draining lymph nodes.A randomized trial compared multimodal therapy (chemotherapy, radiotherapy, and surgery) with surgery alone for esophageal adenocarcinoma. The study included 58 patients in the multimodal group and 55 in the surgery group. At the time of surgery, 42% of the multimodal group had positive nodes or metastases, compared to 82% in the surgery group (P<0.001). Thirteen of 52 patients in the multimodal group had complete pathological responses. The median survival was 16 months for the multimodal group versus 11 months for the surgery group (P=0.01). At one, two, and three years, 52%, 37%, and 32% of the multimodal group were alive, compared to 44%, 26%, and 6% in the surgery group (P=0.01). The survival advantage of multimodal therapy reached significance at three years. The study found that multimodal therapy was superior to surgery alone for resectable esophageal adenocarcinoma. The trial showed that preoperative chemotherapy and radiotherapy reduced the incidence of micrometastases, increased resectability, controlled systemic disease, and allowed accurate assessment of the pathological response. These factors may influence postoperative treatment decisions. The chemoradiotherapy regimen was well tolerated, with few toxic reactions. The study concluded that multimodal therapy followed by surgery provides a significant survival advantage over surgery alone at three years for patients with adenocarcinoma of the esophagus. The results support the findings of nonrandomized studies that have shown a complete pathological response in approximately 20% of patients treated with multimodal therapy. The study also highlights the importance of identifying patients who may benefit from surgery after preoperative treatment. The results suggest that multimodal therapy should be considered in all patients with tumor confined to the esophagus and draining lymph nodes.