Modified transhiatal oesophagectomy is described for the resection of tumours affecting the distal third of the oesophagus. The operation confers the advantages of radical resection and the ability to undertake the procedure under direct vision. Forty patients with a median age of 67 years underwent this operation during a 36-month period and were followed for up to 42 months after surgery. The hospital mortality rate was one of 40 patients and the median postoperative stay 10 days. All but four patients left hospital within 2 weeks of operation. Eighteen of 30 patients were alive at 12 months and seven of 18 at 24 months after operation. Only two patients are known to have developed local recurrence in the tumour bed. This procedure confers the advantages of a radical approach under direct vision and incorporates the principles of near-total oesophagectomy and cervical anastomosis in the treatment of oesophageal cancer.