Lymph node dissection for cancer of the thoracic esophagus: How extended should it be? Analysis of personal data and review of the literature

The extent of lymph node dissection in esophageal cancer is a topic of continuing debate, controversy and clinical investigation. At the present, conflicting results both in term of short-term outcome and long-term survival are reported in the literature. Preliminary results suggest that a more accurate surgical staging and consequently a more realistic long-term prognosis is provided by extended lymphadenectomy. These reasons emphasize the importance of extended lymph node dissection at least for selected carcinomas of the upper and mid thoracic esophagus which are resectable for cure. Prospective randomized trials comparing operative mortality and morbidity rates, and the long-term results after enlarged lympadenectomy and standard esophagectomy are urgently needed.