The authors reviewed the medical records of 36 consecutive patients who underwent pre-operative concurrent chemotherapy (CX) and radiotherapy (RT) followed by esophagectomy from 1994 to 2002. The clinical staging included CT scans and trans-esophageal ultrasound. There were 22 (61%) stage 2 and 14 (39%) stage 3 patients. The median age was 58 (37-80) and median tumor size 5 (2-14) cm. There were 15 (42%) cases of squamous cell carcinoma and 21 (58%)cases of adenocarcinoma. CX consisted of 5FU/cisplatin in 33 patients and taxol/carboplatin in 3. The median RT dose was 50.4 Gy (30-54 Gy). Esophagectomy was performed 4-6 weeks after completing CX and RT. Seventeen (47%) patients had complete responses (pCR) in the esophagus, 10 (28%) had microscopic residual cancer and 9 (25%) had macroscopic residual cancer. Twenty-four (67%) patients had no evidence of lymph node (LN) metastasis and 12 (33%) had evidence of LN metastasis upon esophagectomy. Local recurrence (LR) rate and distant metastasis (DM) rates were 14% and 36%, respectively. The median follow up was 20 (6-96) months and the median survival was 37 months. The univariate analysis of age, tumor size, RT dose, stage, tumor histology, and primary tumor response had no impact on LR, DM, and survival. Only pathologic response in LN had impact on DM. Eight of 12 (66%) patients with residual disease in LN developed DM vs. 5/24 (20%) patients who had no LN involvement, P = 0.01. Multivariate analysis showed 2/15 (13%) patients with stage 2 and pCR/ microscopic residual disease had DM vs 11/21 (52%) patients who did not have those clinical features, P = 0.03. Seven of 13 (54%) patients who developed DM did so within 12 months of esophagectomy. Five 5(14%) patients had a major complication that resulted in death of 2(5.6%). Combined modality therapy resulted in a high rate pCR. However, pathologic response of the primary tumor did not impact survival or LR. The current work up to detect DM may be inadequate in light of a high rate of early DM development.