In order to elucidate problem in the treatment for the intrathoracic esophageal carcinoma we studied the modes of recurrence in 152 patients who underwent curative resection until March 1985. Seventy seven had surgery alone and 75 had surgery combined with radiotherapy or chemotherapy. Among these patients recurrence was seen in 99 patients. The most frequent site of recurrence was in the cervical or upper mediastinum (49%), and secondly in the distant organs (31%). There was not a significant difference in the modes of recurrence between the patients treated by surgery alone and those with combined therapy. On the contrary, in the 13 patients who underwent thorough lymph node dissection in the upper mediastinum, namely, around tracheobronchial trees, rate of recurrence in the upper mediastinum was very low 38% comparing to 15% in other patients and 3-year survival rate also excellent (34% to 54%). These results suggest that extended radical surgery including upper mediastinal lymph node dissection will improve survival, although adjuvant chemotherapy or radiotherapy is still not a proven benefit.