Background: Although surgical resection is the treatment of choice for patients with esophageal squamous cell carcinoma (ESCC), some evidence suggests that definitive chemoradiation (CR) may have equivalent survival compared to surgery alone. The objective of this study was to evaluate current trends in the treatment of ESCC and its impact on overall survival (OS). Methods: Using the NCDB (2004-2013), patients with non-metastatic/loco-regional ESCC were categorized into definitive CR, neoadjuvant CR/surgery, surgery alone, and surgery/adjuvant therapy. Multivariate Cox proportional hazard models by stepwise selection were applied to estimate hazard ratios (HR) of predictors of OS. Results: We identified 11,229 patients with ESCC undergoing definitive CR (n = 8855, 78.9%), neoadjuvant therapy/surgery (n = 953, 8.5%), surgery alone (n = 1130, 10.1%), and surgery/adjuvant therapy (n = 291, 2.6%). The distance of primary tumor from incisors was comparable for all four groups. On multivariable analysis, treatment modality had the largest impact on OS followed by AJCC stage, age and annual surgical volume. Compared to neoadjuvant therapy/surgery, both surgery only (HR 1.17, 95% CI 1.04-1.32) and definitive CR (HR 1.51, 95% CI 1.37-1.66) were associated with increased long-term mortality. However, there was no difference in mortality in the surgery/adjuvant therapy group (HR 1.10, 95% CI 0.94-1.30) compared to the neoadjuvant therapy/surgery group. Patients treated at facilities performing more than 20 esophagectomies per year, regardless of whether they underwent surgical resection, had improved OS compared to facilities performing 10-19 per year (HR 1.47, 95% CI 1.29-1.68), 5-9 per year (HR 1.44, 95% CI 1.29-1.62), and < 5 per year (HR 1.53, 95% CI 1.38-1.70). Conclusions: Patients receiving either neoadjuvant therapy or adjuvant therapy and esophagectomy for ESCC have improved OS compared to patients undergoing esophagectomy alone and definitive CR. These findings suggest that patients with ESCC should be considered for multimodality treatment at high-volume centers and surgery should be included in the treatment plan whenever possible.