Three-field dissection for squamous cell carcinoma in the thoracic esophagus.

An esophageal cancer has frequent metastasis in the cervical and upper mediastinal lymph nodes, in particular along the recurrent nerves. Cervicothoracoabdominal three-field dissection is the most radical and rational lymphadenectomy procedure based on this evidence. During three-field dissection, the nodes along the recurrent nerves from the neck to the mediastinum are more meticulously resected than during any other procedure of radical lymphadenectomy. A consensus has been obtained that complete resection of the recurrent nerve nodes improves the survival rates of patients with cancer in each of the various locations of the thoracic esophagus, and that resection of the supraclavicular and internal jugular nodes improves the survival rates of patients with cancer in the upper thoracic esophagus. There is, however, still some controversies over whether or not resection of the supraclavicular and internal jugular nodes improves the survival rates of patients with cancer in the middle or lower thoracic esophagus. Moreover, there remains many controversies over the indication for three-field dissection regarding metastasis-positivity in the lymph nodes, the numbers of the metastasis-positive nodes, the stage, surgical risks and other aspects. Large randomized prospective studies are needed to accumulate conclusive evidence for the benefits of three-field dissection.