For the last four years, 174 cases of thoracic esophageal cancer have been resected in our department. Stage 4 cancer cases were encountered in 73 cases (42%) of total resected cancer cases. As the location of lesion, 1m was most frequent in 52%, followed by Ei in 23%. The 2-year and 3-year survival rate were 25% and 17% respectively. Analyzing 73 cases of stage 4 cancer, a0-2n3,4 was found in 52 cases (71%), a3n0-2 12(16%), a3n3,4 7(10%) and M1 2(3%). Invasion to the trachea and bronchi was seen in 11 and that to the aorta was in 7. As for surgical procedures, the combined resection of the aorta was performed in two cases. The postoperative course was smooth, however, the prolonged survival was not obtained due to the recurrence of cancer. The lymph node metastasis was widely observed in the cervical region, mediastinum and abdominal cavity. The thoracic paratracheal lymph node metastasis was the most frequent. The lymph node dissection was necessary in these three regions. Especially the sufficient dissection in the upper mediastinal lymph nodes, that is, the right recurrent nerve nodes, the left recurrent nodes and the infraaortic arch nodes, was very important.