Abstract: Objective:To evaluate the pattern of recurrence following total resection of thoracic esophageal squamous cell carcinoma, the relationship between clinical indicators and recurrence patterns, and the significance of adjuvant thera-py.Methods:Data of256 cases with thoracic esophageal squamous cell carcinoma following complete resection, with com-plete follow-up information were retrospectively analyzed. All cases were staged using TNM staging (1997 UICC staging system). The χ2 test was used to compare the rate of excision. Results: There were141 cases with postoperative recur -rence (55.08%), with a mean time of15.1 months (range, 4 to 58months). Of the total relapse cases, lymph node metasta-sis (LNM) occurred in 82(58.16% ), hematogenous metastasis in 15(10.64% ), mixed metastasis (cases with hematoge-nous metastasis accompanied by LNM or recurrence at anastomotic site) in 26(18.44% ), and recurrence at anastomotic site in 18(12.77%). Recurrence of thoracic esophageal cancer was significantly associated with depth of invasion, pTNM stage and lymph node metastasis ( P=0.034 , P=0.037 , P=0.004 ). The LNM from upper thoracic esophageal carcinoma was mainly found in cervical and upper mediastinal nodes. The LNM from middle thoracic esophageal carcinoma were approxi-mately equal in the cervical, mediastinal and abdominal lymph nodes, and abdominal lymph node metastasis predomiminat-ed in lower thoracic esophageal carcinoma. There was significant diffience in LNM and anastomotic-site recurrence be-tween the groups with adjuvant radiochemotherapy (33cases) and without adjuvant therapy (P=0.012 ). However, there was no significant diffience in hematogenous metastasis and mixed metastasis between the groups with adjuvant radio-chemo- therapy ( 13cases) and without adjuvant therapy ( 16cases) ( P=0.065 ). Conclusion:Local LNM was the main recur -rence site following complete resection of thoracic esophageal squamous cell carcinoma. Recurrence of thoracic esopha -geal cancer was closely associated with the depth of invasion, pTNM stage and lymph node metastasis. Most lymph node metastases from upper thoracic esophageal carcinoma were found in cervical and upper mediastinal nodes and abdominal lymph node metastasis predomiminated in lower thoracic esophageal carcinoma. Postoperative radiochemotherapy is of statistical significance for the control of local reccurence.