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The Institutional Review Board of Zhejiang Cancer Hospital approved the study and the need for individual patient consent was waived. The cohort of patients included 194 males and 41 females with an average age of 58 ranging [You must be registered and logged in to see this link.] from 37 to 79 years old. Preoperative evaluation included endoscopy with biopsy, barium swallow examination, computerized tomography of the chest and upper abdomen, and ultrasound of the neck. Pulmonary and cardiac function tests were routinely performed to assess medical operability. Histological diagnosis of each of the patients was established before treatment. Tumor location, grade, and stage were defined according to the 7th edition of UICC TNM classification. Recurrent laryngeal nerve palsy and the presence of clinical supraclavicular or cervical nodal involvement were considered a contraindication for surgery.

In our institution, two types of lymphadenectomy were performed for esophageal cancer depending on the operators surgical preference. Four surgeons performed 2 field lymphadenectomy, while 2 performed 3 field lymphadenecotmy as a chief operator. Surgical procedure A transthoracic esophagectomy was performed for each of the 235 [You must be registered and logged in to see this link.] patients with either a 2 field or a 3 field lymphadenectomy. The surgical procedure of esophagectomy with 2 field lymphadenectomy was described previously. In principle, this procedure consisted of esophagectomy with total mediastinal lymphadenectomy through a right thoracotomy, and upper abdominal lymphadenectomy through an upper median laparotomy.

Total mediastinal lymphadenctomy was performed according to the classification defined by the International Society for Diseases of the Esophagus. The extent of lymphadenectomy involved dissection of the bilateral RLNs, paratracheal, brachiocephalic artery, paraesophageal, [You must be registered and logged in to see this link.] and infraaortic arch nodes, in addition to the middle and lower mediastinal nodes. Upper abdominal lymphadenectomy was performed to include the paracardial, lesser curvature, left gastric, common hepatic, celiac, and splenic nodes. The 3 field lymphadenectomy included cervical lymphadenectomy of the paraesophageal, deep cervical, and supraclavicular nodes in addition to 2 field lymphadenectomy performed through a collar cervical incision. Esophageal anastomosis was performed in the neck for each patient. Gastrointestinal continuity reconstruction was achieved by stomach bypass in 233 patients and by colon conduit in 2 patients.

After surgery, the anatomical location of the removed nodes were labeled by the operating surgeon, and then histologically examined with hematoxylin and eosin staining. Follow up Complete follow up information was available for all patients. Survival time was defined as the period from the date of surgery till death or the most recent follow up in March 2013. The duration of follow up ranged from 1 month to 131 months. One hundred and sixty four patients died, and the remaining 71 were still alive at the last contact. Statistical analysis Survival curves were constructed using Kaplan Meier method, and log rank test was used to determine significance.