**1. Introduction**

Esophageal carcinoma is strongly invasive and is accompanied by numerous malignant tumors. It is mainly seen in Asia and East Africa. In the eastern countries, especially in Japan, extended lymph node dissection, including the abdominal, upper, middle, lower mediastinal,

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

and occasionally cervical lymph nodes, is suggested as a standard surgical method because systematic dissection of metastatic lymph nodes is thought to improve survival and lead to cure.

Consequently, recommending complete lymphadenectomy of the upper mediastinum is an essential component in radical esophagectomy for esophageal squamous cell carcinoma (ESCC). Three-field lymphadenectomy (3FL) is the ultimate surgical procedure in the pursuit of complete lymph node dissection for thoracic esophageal cancer. However, lymph node dissection along the recurrent laryngeal nerve (RLN) is difficult because severance of nerves by electrical devices can easily lead to paralysis [1, 2].

The prone position provides better visualization in the subaortic arch and subcarinal and supraphrenic regions, but the working space in the left upper mediastinum for dissecting the lymph nodes along the left recurrent laryngeal nerve is limited. Some investigators, including us, have shown how to obtain a good operative field in the upper mediastinum for lymph adenectomy. Osugi reported that tracheobronchus must be retracted ventrally to visualize the left side of the trachea and developed the retractor that provides exposure of the entire mediastinum and esophagus in left lateral position [3]. In eastern countries, surgeons also describe lymphadenectomy along the left recurrent laryngeal nerve, but few surgeons in western countries have discussed lymphadenectomy of esophageal adenocarcinoma (EAC). Here, we describe differences in lymph node metastasis between ESCC and EAC and procedures for lymph node dissection along the recurrent laryngeal nerve in ESCC.
