To assess the morbidity and mortality of preoperative radiation therapy (RT), the authors reviewed 37 consecutive patients who underwent transhiatal esophagectomy for carcinoma of the esophagus. Twelve patients received no RT, 13 patients received RT only to the neck, and 12 received RT to the chest (three of these received radiation therapy to the chest and neck). Preoperative chest RT did not significantly increase postoperative fistula formation but was associated with significantly higher operative mortality, overall complication rate, and time on ventilators than either the patients receiving neck RT alone or no RT (P less than 0.05). Postoperative hospital stay was longer and intraoperative blood loss greater for the chest RT group compared to those with no RT (P less than 0.05). Neck RT did not result in these complications (P = NS). The authors conclude that preoperative chest RT is associated with significant postoperative morbidity and mortality.