Introduction: A clinicopathological study of diagnosis and treatment for esophageal cancer in Hiraka General Hospital was performed.Patients and Methods: We retrospectively analyzed clinical records of 417 esophageal cancer patients treated between January 1998 through December 2009.Results: It was presumed that we took care of about 10% of esophageal cancer patients in Akita prefecture. Sixty-six percent of the patients were referred to our hospital from other medical facilities during the period under review. On the other hand, those patients with esophageal cancer detected by medical examination or health screening accounted for only 9.6%. The rate of those patients who could receive definitive therapies was 75% (313 cases), and 308 cases (98%) underwent curative surgical resection in Hiraka General Hospital. Among the patients who had received therapy aimed for complete cure, 285 patient (91.1%), went through treatment as planned, and the complete response rate was 73%. Five-year survival rates of all the patients in stage 0, stage I, stage II, stage III and stage IV were 44.7%, 76.3%, 67.3%, 38.0%, 31.6% and 15.6%, respectively. These survival rates are never be inferior to those of major centers for esophageal cancer in Japan. Long term survival rates of the patients who had been diagnosed with esophageal cancer by medical examination or health screening were statistically significantly better than those of the patients who were diagonosed by another categories. Among the 209 patients who responded completely to definitive therapy, the cancer recurred in 50 patients (23.9%). Among the 50 recurrent group, recurrence has been primarily recognized in 33 patients (67%) with in 12 months after definitive therapy and in 40 patients (82%) within 24 months. Therefore, a close follow-up is very important up to 24 months after treatment. As for the cause of death in patients who underwent curative resection the death from esophageal cancer accounted for 66% whereas the death from other diseasea and/or other type of cancer accounted for 34%.