Does it matter that lymphadenectomy through right or left side thoracotomy during esophagectomy?

Lymph node metastasis is one of the critical determinants in the prognosis of esophageal cancer. Many lymph node-associated parameters, such as regional or nonregional location (1,2), number of positive nodes (3-6), number of total harvested nodes (7), ratio of positive to total nodes (5,6,8), and even number of negative nodes (9), have been reported to have prognostic relevance. There are also abundant studies assessing the diagnostic and therapeutic value of lymphadenectomy (10,11). The diagnostic purpose of lymphadenectomy is to identify the presence of lymphatic spread, which can be a surrogate of systemic disease. Although lymph node dissection itself may not have a survival benefit, the adjuvant treatments for lymph node metastasis are expected to. However, if viable malignant cells initially nest in lymph nodes and gradually spread to systemic metastases, lymphadenectomy would be an opportunity to cure patients, especially those with early phase of lymphatic dissemination.