PURPOSE: To determine whether preoperative CT is helpful in predicting the development of recurrent tumor following surgical resection in patients with esophageal cancer. MATERIALS AND METHODS: Thirty patients with esophageal cancer in whom preoperative CT of the chest had been performed were included in the study. All had undergone esophagectomy, esophagogastrostomy and lymph node dissection at our institution between 1995 and 1997. They were divided into two groups according to the development of tumor recurrence during the follow-up period of three years. Sixteen patients (group I) suffered tumor recurrence, while the other 14 (group II) remained tumor-free after surgery. In each group, a review of the preoperative CT scans indicated the length, thickness, location and margin of the tumor, and the presence or absence of lymphadenopathy in the mediastinum and/or upper abdomen. Differences in preoperative CT findings between the two groups were assessed by statistical testing. RESULTS: Lymphadenopathy of the mediastinum and/or upper abdomen was seen in 11 (69%) of 16 patients in group I and three (21%) of 14 in group II (p<.05). The tumor margin was indistinct in seven patients (44%) in group I and in one (7%) in group II (p<.05). The average length and thickness of esophageal tumors were 5.2 and 1.4 cm, respectively, in group I, and 3.5 and 1.5 cm, respectively, in group II (p>.05). In group I, five esophageal tumors were located in the middle esophagus and eleven in the lower esophagus. In group II, such tumor was located one in the upper esophagus, six in the middle esophagus, and seven in the lower esophagus (p>.05). CONCLUSION: Patients with preoperative CT findings of lymphadenopathy and/or an indistinct primary tumor margin are more likely to develop tumor recurrence following surgical resection than those without these findings.