Objective: To retrospectively investigate the patterns of recurrence and its related factors in patients with stage pT2N0-1M0 thoracic esophageal squamous cell carcinoma (ESCC) after radical resection. Methods: Two hundred and twenty-two cases of stage pT2N0-1M0 thoracic ESCC treated in our hospital from 2008 to 2011 were enrolled. There were 142 males and 80 females. There were 181 cases in stage pN1 and 41 cases in stage pN1. 142 patients were treated with surgery alone and 80 with adjuvant postoperative chemotherapy (POCT). The diagnosis of recurrence was made primarily on the basis of CT images. Results: Follow-up ended on Sep 30, 2014. The overall recurrence rate was 35.1%. Locoregional recurrence (LR) was found in 25.7% of patients, distant metastasis (DM) in 5.9%, and LR plus DM in 3.6%, respectively. Locoregional recurrence accounted for about 83.3% of any recurrence, and 87.7% of the LR was in the mediastinum (91.2% of the mediastinal recurrence was located in the upper mediastinum). Multivariate Cox regression analysis showed that pN is independent factor affecting the total recurrence, LR and DM (P<0.05 for all). The total recurrence rate, LR and DM in pN1 patients were 7.1-, 6.5- and 3.1-fold higher than that in pN0 patients, respectively. The total risk of recurrence in females was about 49.1% of that of males. The POCT was not significantly related with the tumor recurrence (P>0.05). Conclusions: The recurrence rate is high in patients with stage pT2N0-1M0 thoracic ESCC after radical resection. The most common site of recurrence is mediastinum, especially the upper mediastinum. Recurrence more frequently occurs in stage pN1 and males, and POCT could not reduce the risk of recurrence.