Carcinomas of the pharyngo-oesophageal junction continue to be a challenge to head and neck surgeons. We report a series of 30 patients who underwent gastric transposition for advanced pharyngo-oesophageal tumours, with personal insights about the surgical technique and the need for neck and mediastinal node dissection. The median hospital stay was 21.6 days, with resumption of oral feedings around the 16th day in 91.7 per cent of the surgical survivors. Ten patients had multiple primary tumours (33.3 per cent), with 20 per cent of synchronous carcinomas. Serious local and systemic complications occurred in 17 patients (56.7 per cent), the most important being tracheal complications, cervical and systemic infections, fistulas, rupture of major vessels and pulmonary embolus. Post-operative deaths occurred in 20 per cent of the patients. The locoregional control of disease was significant (only 14.2 per cent of deaths from regional recurrence) but 64.2 per cent of the patients died from distant metastasis. Survival without disease was 13.3 per cent at five years. Gastric transposition was judged to be the procedure of choice for palliation or occasional cure in patients with pharyngo-oesophageal tumours.