Background: Surgery represents the cornerstone for the treatment of esophageal cancer which usually presents in advanced stages with very low rate of operability. The preoperative treatment increases the operability and resectability rates in advanced stages. Objective: To review the surgical outcome in terms of morbidities and mortalities, the overall survival and disease free progression for locally advanced (stages 2 and 3) esophageal and gastroesophageal junction cancer(GEJ) whether after upfront surgery or after administration of neoadjuvant therapy. Patients and methods: A retrospective review of the management of patients diagnosed with locally advanced esophageal cancer (LAEC) or gastroesophageal junction (GEJ) cancer (stages 2, 3) presenting to the NCI in Cairo during the period from 2010 to 2015. Results: 50 patients met the study criteria, neoadjuvant chemotherapy (NAC) was given to 32% (16 patients) followed by Complete R0 surgical resection in 62.5% while 37.5 %( 6 cases) was inoperable. Upfront surgery was done in 68% (34 cases) and all were operable. Overall survival was better after neoadjuvant chemotherapy especially with epirubicin and oxaloplatin, capcitabin (xeloda) (EOX) chemotherapy regimen given for adenocarcinoma pathology subtype followed by surgery with a p value of 0.032. Better disease free survival at 1 and 2 years with a p value of 0.008.ICU admission were shorter after neoadjuvant therapy with a p value of 0.013.No statistical significant difference in morbidity and mortality and the negative resection margins. More radical resections were required in the upfront surgery group. Conclusion: Neoadjuvant therapy should be used as a standard therapy before surgery for all patients presenting with locally advanced esophageal and GEJ cancer due to better overall survival and a disease free survival, shorter ICU admission and less extensive surgery needed. Keywords: Esophageal cancer, overall and disease free survival, extent of surgery, pathological response.