This prospective, randomized trial compared the outcomes of multimodal therapy (chemotherapy and radiotherapy followed by surgery) with surgery alone for patients with resectable esophageal adenocarcinoma. The study included 113 patients, with 58 assigned to multimodal therapy and 55 to surgery alone. The median survival was 16 months for the multimodal group and 11 months for the surgery group, with a significant survival advantage favoring multimodal therapy at three years (P=0.01). The complete pathological response rate was 25% in the multimodal group, compared to 6% in the surgery group. Treatment-related toxicity was low, and the regimen was well-tolerated. The results support the use of multimodal therapy followed by surgery as a superior approach for patients with resectable esophageal adenocarcinoma.This prospective, randomized trial compared the outcomes of multimodal therapy (chemotherapy and radiotherapy followed by surgery) with surgery alone for patients with resectable esophageal adenocarcinoma. The study included 113 patients, with 58 assigned to multimodal therapy and 55 to surgery alone. The median survival was 16 months for the multimodal group and 11 months for the surgery group, with a significant survival advantage favoring multimodal therapy at three years (P=0.01). The complete pathological response rate was 25% in the multimodal group, compared to 6% in the surgery group. Treatment-related toxicity was low, and the regimen was well-tolerated. The results support the use of multimodal therapy followed by surgery as a superior approach for patients with resectable esophageal adenocarcinoma.