Background: To determine the impact of esophagectomy on survival in patients with adenocarcinoma (AC) of the esophagus cancer after chemoradiation (CRT). Methods: A database of esophageal cancer was queried for nonmetastatic patients with AC treated between 2000 and 2011 with CRT. Overall survival (OS) and recurrence-free survival (RFS) curves were calculated according to the Kaplan-Meier method and log-rank analysis. Multivariate analysis (MVA) was performed by the Cox proportional hazard model. Results: We identified 154 patients (60 without surgery; 94 with surgery) who were included in the analysis. The only differences between the 2 groups were more advanced stage and younger age in the surgery group. Patients undergoing surgery had significantly higher survival. Median and 5 year OS for surgical patients was 4.1 years and 43.6% versus 1.9 years and 35.6% for non surgical patients (p=0.007). MVA for OS and DFS revealed that factors associated with increased survival were surgical resection, tumor length <5 cm, male gender, and lower stage. Age, tumor location, radiation dose/technique, and induction chemotherapy were not prognostic. There was a trend towards improved survival on univariate analysis (p=0.10) and MVA (p=0.063) for surgery patients compared to non-surgical patients who were healthy enough for surgery pre-CRT (n=38), and no difference in OS in nonsurgical patients healthy enough for surgery post-CRT (n=22). Conclusions: Esophagectomy after CRT dramatically improves survival in patients with AC after CRT. Trimodality therapy should continue to remain the standard of care for esophageal AC. However, surgery should be performed at high volume centers.