For a study, the researchers sought to determine if adjuvant treatment was linked with a survival advantage in patients with high-risk T2-4a distal esophageal adenocarcinoma pathologically node-negative. Older patients with pT2-4aN0M0 esophageal adenocarcinoma who underwent definitive surgery (2004–2015) and had features classified high risk by the NCCN were identified using the National Cancer Database. Patients were divided into 2 groups based on whether they had received adjuvant chemotherapy with or without radiotherapy. Overall survival was the primary outcome, and it was assessed using Kaplan-Meier and multivariate Cox Proportional Hazards models. A 1:1 propensity score-matched analysis was done to compare survival between the groups. There were 433 individuals who fit the criteria of study, with 313 (78%) receiving no adjuvant therapy and 90 receiving adjuvant chemotherapy with or without radiation (22%). Adjuvant chemotherapy with or without radiation was not linked with a mean survival advantage compared to no adjuvant therapy in both unadjusted and multivariate analyses. Adjuvant chemotherapy was not independently related with a survival benefit in a subgroup analysis of 335 patients lacking high-risk characteristics according to NCCN criteria. Independent of the existence of high-risk factors, adjuvant chemotherapy with or without radiation was not linked with a substantial survival advantage in totally resected, pathologically node-negative distal esophageal adenocarcinoma. The risks and benefits should be evaluated before administering adjuvant therapy to patients with totally resected pT2-4aN0M0 esophageal adenocarcinoma.