[Selection of surgical approaches and lymph node dissection in the esophageal cancer patients]

According to the different surgical approaches and its corresponding lymph node dissection modes, surgical treatment for esophageal cancer can be divided into different surgical treatment modes. Currently in China, the surgical treatment modes for esophageal cancer including left and right thoracic approaches and its corresponding lymph node dissection modes (two-field or three-field) are widely practiced. Different surgical approaches may influence lymph node dissection results, and it may eventually affect the survival of the esophageal cancer patients, therefore, individual selection of appropriate surgical approaches and lymph node dissection extent for esophageal cancer patients based on precise preoperative examinations and clinical stages is very important. By summarizing the recent domestic and foreign research results, it demonstrates that 2-field lymph node dissection by right approach is more radical than left approach, 3-field lymph node dissection by right approach is more radical than 2-field right approach, and may eventually improve the prognosis of patients. However, most of them are retrospective studies which need large sample randomized controlled trials support. This article reviews and summarizes recently published literatures, and discuss the selection of surgical approach and the extent of lymph node dissection for esophageal cancer from three aspects that the effect of left and right thoracic approach on lymph node dissection and prognosis, how to choose individual surgical approach by different position and stage, and what kind of patients need right thoracic approaches with 3-field lymph node dissection.