Abstract: Objective To analyze local-regional recurrence patterns of thoracic esophageal carcinoma after three-field lymph node dissection（3-FLD） with and without postoperative radiotherapy in order to assess the value of postoperative radiation for local control. Methods We reviewed local-regional recurrence patterns in 239 patients with thoracic esophageal squamous cell carcinoma treated with 3-FLD between 2005 and 2010.Of the 239 patients，64 received postoperative prophylactic radiotherapy and 175 did not. Results Recurrence in lymph nodes was 90.29% among patients who did not receive postoperative radiotherapy， and it was 95.31% among those who did.Rates of lymph node recurrence were highest in the mediastinal area， lower in the cervical area，and lowest in the abdominal area.Among patients who did not receive postoperative radiotherapy，the rate of abdominal lymph node recurrence was lower in the upper thoracic area than in the middle or lower thoracic areas（X²  =9.452，P=0.009）.The rate of recurrence in the superior mediastinal lymph node was higher among patients who did not receive radiotherapy than among those who did（X²  =7.615，P=0.006）. The two groups did not differ significantly in recurrence rates at the cervical lymph nodes（X² =1.242，P=0.265），mediastinal lymph nodes（X² =0.023，P=0.880），or abdominal lymph nodes（X²=1.470， P=0.225）. Conclusions Risk of recurrence is greatest in superior，middle mediastinum and neck lymph nodes in patients with thoracic esophageal carcinoma after 3-FLD.Postoperative radiotherapy reduces the risk of recurrence in the superior mediastinal lymph nodes，and the felds of these lymph nodes should be delineated as the postoperative prophylactic irradiation target volume.Metastasis to lower thoracic and abdominal lymph nodes may be an indication for irradiating the corresponding abdominal lymph node region.

Key words: Esophageal neoplasms, Surgery, Recurrence, Postoperative radiotherapy