The role of lymphadenectomy in esophageal cancer

The role of lymph node dissection for resectable esophageal carcinoma has remained controversial, addressed by two contradictory groups of surgeons: the more conservative ones considering esophageal carcinoma with lymph node metastasis to be a systematic disease and the others, supporters of extended lymph node dissection, viewing the metastatic disease phenomenon in sequential manner. In favor of extended lymphadenectomy that allows better postoperative staging, there are also the consistent event of skipping metastasis and the high rate of micrometastasis found mostly with immunohistochemical testing. The discussed concept of sentinel lymph node evaluation does not seem a feasible approach to esophageal cancer. Although there are not undoubted results that three-field resection may offer a survival benefit, before these techniques can be widely adopted, we need more experience and randomized studies to substantiate the benefit of such radical surgery.