Abstract Background The aim of this study is to explore whether the metastasis of the recurrent laryngeal nerve node can guide neck-field lymph node dissection of esophageal squamous cell carcinoma. Methods collected data from 58 patients who had undergone intraoperative pathological frozen of bilateral recurrent nerve node and three-field lymph node dissection in Fujian medical university union hospital, to explore the relationship between recurrent laryngeal nerve node metastasis and cervical lymph nodes metastasis. Results In the positive right laryngeal node group, 31.58% of the patients had metastasis in the cervical lymph nodes, and patients with negative laryngeal node, 10.26% of the patients had metastasis (P0.05). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value were 70.00%, 70.83%, 70.69%, 33.33% and 91.89%. In the positive left laryngeal node group, 55.56% of the patients had metastasis, and patients with negative laryngeal node, 10.20%of the patients had metastasisP0.05. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value were 50.00%, 91.67%, 84.48%, 55.56% and 89.80%. In the positive laryngeal node group(one of the laryngeal node were positive), 33.33% of the patients had metastasis, In the negative group, 5.88% of the patients had metastasisP0.05.The sensitivity, specificity, accuracy, positive predictive value, negative predictive value were 80.00%, 66.67%, 68.97%, 33.33% and 94.12%. In the group of bilateral laryngeal node metastasis, 66.67% of the patients had metastasis. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of the preoperative neck ultrasound combined with PET/CT were 20.00%, 83.33%, 72.41%, 20.00%, 83.33%. Table 1 The statistics about the intraoperative pathological frozen of bilateral recurrent nerve node and the preoperative neck ultrasound combined with PET/CT Conclusion If intraoperative pathological frozen prompted positive, we can decide whether three-field lymph node dissection should be performed combined with preoperative examination, tumor location and degree of tumor infiltration to get appropriately stage and achieve the purpose of radical.Intraoperative pathological frozen state of recurrent nerve node metastasis is an indicator for the selection of neck-field dissection in thoracic esophageal carcinoma. Disclosure All authors have declared no conflicts of interest.