Our treatment strategy for esophageal cancer is as follows; mucosal cancer with the minimal risk of lymph node metastasis is treated by endoscopic mucosal resection (EMR). Submucosal cancer and more invasive lesions are surgically treated by thoraco- and aparoscopy-assisted esophagectomy. In May 1997, the first case received totally endoscopic esophagectomy, and which is survival with no tumor recurrence. Fifty consecutive cases successfully received endoscopic esophagectomy. This surgery should be performed as one major component of the multi-disciplinary treatment.