Appropriate extent of lymphadenectomy in esophageal cancer

Because of the high frequency and widespread distribution of lymph node metastasis in esophageal cancer, three-field dissection was introduced in the early 1980s. Although improvement in the long-term survival rate of patients who undergo three-field dissection has been reported, the clinical significance of cervical lymphadenectomy is still controversial because the effect of improved upper-mediastinal lymphadenectomy in these patients cannot be excluded. Recently, the sentinel node (SN) concept has been validated in gastrointestinal cancers including esophageal cancer using the radio-guided method. Aberrant drainage routes from the primary lesion have frequently been observed in esophageal cancer and are detectable by radio-guided SN mapping. SN navigation is useful to identify SNs as the functional first basin to evaluate the regional lymph node status and to determine the indications for extensive lymphadenectomy in patients with esophageal cancer. Individualized surgical management of patients with esophageal cancer is essential to improve the quality of life of patients and long-term results.