Esophagectomy is associated with significant peri-operative morbidity. Nonetheless, it is realistic to expect that complication rates related to this formidable procedure will decrease. Progress will likely stem not from changes in surgical technique, but from overall advances in medicine, strides in critical care, and more accurate means of preoperative assessment. In contrast, the outlook for functional problems following esophagectomy is more pessimistic. While dumping, delayed gastric emptying, esophageal reflux, and the nutritional insufficiency that accompanies these problems cannot be solved, perhaps their frequency and severity can be moderated.