Key Points

• Three-field lymph node dissection for squamous cell cancer of the esophagus was pioneered by Japanese surgeons. Such an extended resection clearly shows that 25% to 40% of patients have occult metastases to the recurrent laryngeal and/or deep cervical nodes.
• Western experience with this technique is limited to just a handful of centers where adenocarcinoma is the predominant cell type. The prevalence of occult nodal metastases to the recurrent laryngeal and/or cervical nodes in esophageal adenocarcinoma is 20% to 30% and can be predicted by tumor location, depth of invasion, and by nodal metastatic burden
• In experienced hands, three-field lymph node dissection can be performed safely with a hospital mortality of less than 5% and with only slightly increased morbidity compared to two-field dissections.
• In the absence of adequately powered randomized trials comparing two- and three-field dissection, the existing retrospective data suggest that dissection of the “third field” (the recurrent laryngeal and/or cervical nodes) may improve survival of patients with squamous cell carcinoma. This is supported by comprehensive meta-analyses. In patients with adenocarcinoma, the procedure results in optimal nodal staging information; however, its impact on survival is unclear.