Adenocarcinoma of the esophagus continues to increase in incidence and has become a significant health problem in Western countries. While mortality rates are slowly improving from this disease, multimodality treatment, including esophagectomy, has remained critical for optimal outcomes. Esophagectomy has been described as an operation with significant morbidity and mortality, but over the last decade, increased utilization of minimally invasive esophagectomy in an effort to reduce the high rates of morbidity and lengthy hospital stays associated with open esophagectomy has been adopted at many medical centers. We review esophageal cancer treatment modalities, considerations in the current context of neoadjuvant therapy, and increased adoption of minimally invasive approaches.