Esophageal resection is a major operation, requiring a high level of surgical skill, experience and knowledge of the anatomy of the thorax, neck and abdomen. The immediate and late results of this operation vary considerably. This article reviews the world literature, attempting to examine whether there is a need to establish guidelines restricting the performance of esophageal resection to a limited number of medical centers. A wide review of the world literature shows that the results of esophageal resection depend on the experience of a single surgeon, or a specific medical center. The operative mortality is significantly lower in high-volume centers and in hospitals dedicated to cancer surgery. In the absence of reports on surgical results from Israel, conclusions must be drawn from recommendations in the literature. It is suggested that esophageal resection be limited to medical centers performing more than five esophageal resections per year.