Patterns of disease recurrence were reviewed in 108 patients who had curative resection for squamous cell cancer of the thoracic oesophagus. At a median follow-up of 20 months, 56 patients (52 per cent) had recurrence. Most presented within 2 years. Extrathoracic recurrence was found in 41 per cent of patients and intrathoracic recurrence in 25 per cent. Systemic organ metastases (26 per cent) were as frequent as intrathoracic recurrences. Twelve patients (11 per cent) developed cervical lymph node (CLN) recurrence; their mean time to recurrence was 12.6 months, compared with 13.1 months for recurrence at locations other than the neck (P = 0.8). Median survival was 23 and 13 months respectively (P = 0.27). Preoperative chemotherapy lowered the recurrence rate from 60 per cent to 30 per cent, (P = 0.01) but did not affect survival. The addition of cervical lymphadenectomy would benefit few patients and must be counterbalanced with increased morbidity and cost. The frequency of systemic organ metastases calls for further investigation of the possible benefits of chemotherapy.