Background: Recurrent disease (RD) after potentially curative treatment for esophageal or junctional cancer is common and survival after recurrence is poor. Potentially curative strategies are possible in limited occasions and palliative systemic therapy or supportive care are often the only therapies possible. Little is known about survival after recurrence and factors influencing treatment success. We aimed to assess the recurrence patterns and overall survival (OS) of patients who developed RD after curative treatment. Methods: Patients with RD of esophageal or junctional cancer between 1994 and 2014 after potentially curative esophagectomy preceded by neoadjuvant chemo(radio)therapy were included in this retrospective cohort study. A logistic regression analysis was performed to assess predictive factors for receiving treatment aimed at radical tumor eradication. Results: Recurrence was diagnosed in 219 of 503 patients (43.5%). 212 of 219 patients (96.8%) were evaluable for dissemination patterns and 204 (93.2%) for treatment strategies. Locoregional failure (LRF) was diagnosed in 23 patients (10.5%) and distant metastases (DM) in 189 patients (86.3%). Patients with LRF had a median OS of 4.9 months (CI 95%, 0.0-15.6) and patients with DM 2.9 months (CI 95%, 2.1-3.6), p < 0.05. Treatment aimed at radical tumor eradication was applied in 28 patients (13.7%), 11 of whom had DM and 17 LRF. Patients who were free of DM and had a longer interval between surgery and recurrence had a higher chance of receiving treatment aimed at radical tumor eradication (OR 8.7; CI 95%, 3.3-22.6; p < 0.05). Palliative treatment was applied in 94 patients (46,1%), 88 of whom had DM and 6 LRF. Supportive care was applied in 82 patients (40.2%), 6 of whom had DM and 73 LRF. Median OS was 13.6 months (CI 95%, 6.0-21.3) in radically treated patients, 4.7 months in palliative treated patients (CI 95%, 3.9 to 5.5) and 1.1 months in patients who received supportive care (CI 95%, 0.6-1.5), p < 0.05. Conclusions: Treatment aimed at radical eradication of RD is possible, even when DM are involved, and is associated with better survival compared to palliative treatment or best supportive care.