Of 1,579 patients undergoing esophagectomy for esophageal cancer, 60 patients underwent up-front surgery for cT2 N0 M0 esophageal cancer, of whom 8 (13 percent) were found to have pathologic T2 N0 M0, 16 (27 percent) were pathologically downstaged, and 36 (60 percent) were upstaged, 7 (19 percent) on the basis of pathologic T stage, 14 (39 percent) on pathologic N stage, and 15 (42 percent) had upstaging of T and N stages. Dysphagia and high maximum standardized uptake value of the tumor were predictive of more advanced underlying disease.