Reasonable lymph node dissection in cancer of the lower esophagus

The extent of lymphadenectomy in surgery for esophageal cancer continues to be a topic of controversy. Some surgeons consider esophageal carcinoma with nodal involvement as a systemic disease and advocate transhiatal resection (1). Others advocate a trans-thoracic approach with an extensive lymph node dissection (2). In contrast to what it was believed only a few decades ago, esophageal cancer is regarded today as a potentially curable disease. This is especially true for tumors which, irrespective of the histological type, are located distal to the tracheal bifurcation. In this location, a standard or en bloc dissection is usually feasible and, in order to be most effective, it should incorporate in the operative specimen all the potentially involved regional lymph nodes (3). The aims of this study were to analyse long-term survival after esophagectomy for cancer of the lower esophagus, and to evaluate the results of an enlarged mediastinal lymphadenectomy in this category of patients.