This study, conducted by the Second Department of Surgery at Tohoku University, evaluates the significance and issues of upper mediastinal lymph node dissection (UMND) in patients with thoracic esophageal cancer. The trial, a prospective randomized design, was initiated in January 1987 and continued until December 1993. The primary aim was to objectively assess the effectiveness of UMND compared to standard lymph node dissection (SLND). The trial included 264 patients with thoracic esophageal cancer, of whom 71 (26.9%) met the entry criteria. These patients were randomly assigned to receive either UMND or SLND. Postoperatively, patients were further randomized to receive either radiochemotherapy or chemotherapy alone. - **Lymph Node Dissection Ranges**: UMND involves additional nodes in the upper mediastinum and neck, while SLND focuses on the standard nodes. - **Surgical Techniques**: Detailed descriptions of the surgical procedures for both UMND and SLND are provided, including the approach to the mediastinum, abdomen, and neck. - **Postoperative Management**: Patients were closely monitored for respiratory and circulatory functions, and nutritional support was provided pre- and postoperatively. - **Lymph Node Metastasis Rates**: UMND showed a higher rate of metastasis in the left 106 node and right 106 node. - **Circulatory and Respiratory Functions**: No significant differences were observed between the two groups in terms of circulatory parameters and early respiratory recovery. - **Direct Surgical Outcomes**: UMND had a slightly higher complication rate, particularly in terms of phrenic nerve palsy and prolonged tracheostomy use. - **Distant Disease-Free Survival**: UMND showed a trend towards better distant disease-free survival, but the difference was not statistically significant. - **Quality of Life**: Postoperative quality of life was similar between the two groups. The study suggests that UMND may improve distant disease-free survival in thoracic esophageal cancer, but the benefits are not statistically significant. The high complication rate and the need for careful postoperative management highlight the challenges of this approach. Future prospective randomized trials are necessary to further evaluate the effectiveness of UMND in improving outcomes.This study, conducted by the Second Department of Surgery at Tohoku University, evaluates the significance and issues of upper mediastinal lymph node dissection (UMND) in patients with thoracic esophageal cancer. The trial, a prospective randomized design, was initiated in January 1987 and continued until December 1993. The primary aim was to objectively assess the effectiveness of UMND compared to standard lymph node dissection (SLND). The trial included 264 patients with thoracic esophageal cancer, of whom 71 (26.9%) met the entry criteria. These patients were randomly assigned to receive either UMND or SLND. Postoperatively, patients were further randomized to receive either radiochemotherapy or chemotherapy alone. - **Lymph Node Dissection Ranges**: UMND involves additional nodes in the upper mediastinum and neck, while SLND focuses on the standard nodes. - **Surgical Techniques**: Detailed descriptions of the surgical procedures for both UMND and SLND are provided, including the approach to the mediastinum, abdomen, and neck. - **Postoperative Management**: Patients were closely monitored for respiratory and circulatory functions, and nutritional support was provided pre- and postoperatively. - **Lymph Node Metastasis Rates**: UMND showed a higher rate of metastasis in the left 106 node and right 106 node. - **Circulatory and Respiratory Functions**: No significant differences were observed between the two groups in terms of circulatory parameters and early respiratory recovery. - **Direct Surgical Outcomes**: UMND had a slightly higher complication rate, particularly in terms of phrenic nerve palsy and prolonged tracheostomy use. - **Distant Disease-Free Survival**: UMND showed a trend towards better distant disease-free survival, but the difference was not statistically significant. - **Quality of Life**: Postoperative quality of life was similar between the two groups. The study suggests that UMND may improve distant disease-free survival in thoracic esophageal cancer, but the benefits are not statistically significant. The high complication rate and the need for careful postoperative management highlight the challenges of this approach. Future prospective randomized trials are necessary to further evaluate the effectiveness of UMND in improving outcomes.