[Esophagectomy with lymph node dissection through right thoracotomy]

In esophageal cancer, the incidence of lymph node metastasis is much higher than that in gastric or colonic cancer. Lymph node metastasis is frequently found along the recurrent laryngeal nerve and around the gastric cardia. The accuracy rate of preoperative diagnosis of lymph node metastasis is up to 80%, in spite of vigorous diagnostic efforts. In Japan, "esophagectomy with 3-field lymph node dissection through a right thoracotomy" is the standard surgery for advanced esophageal cancer. However, based on the "Comprehensive Registry of Esophageal Cancer in Japan," this standard operation does not prevail nationwide. Although, it is difficult to obtain evidence showing the effects of lymph node dissection for ethical reasons, we must continue accurate lymph node dissection with the best surgical techniques to improve patient survival.