A prospective randomized trial was conducted to evaluate the significance and issues of cervical upper mediastinal lymph node dissection (cervical upper mediastinal lymphadenectomy) for thoracic esophageal cancer. From January 1987 to December 1993, 71 patients with thoracic esophageal cancer met the inclusion criteria and were randomly assigned to either cervical upper mediastinal lymphadenectomy (expanded lymphadenectomy) or standard lymphadenectomy. The results showed that the expanded lymphadenectomy group had a lower lymph node metastasis rate in the upper mediastinum, particularly in nodes 105, right 106, and left 106. However, the survival rates at 2 and 5 years were 83.3% and 66.2% for the expanded group, compared to 64.8% and 48.0% for the standard group, with no statistically significant difference (p=0.192). The recurrence rate was lower in the expanded group (12.9% vs. 24.1%), with 3 out of 4 recurrences occurring in the mediastinum or neck. The expanded lymphadenectomy was associated with higher postoperative complications, including delayed recovery of cough reflex, higher incidence of recurrent laryngeal nerve palsy, and more frequent tracheostomy. However, the quality of life and postoperative survival were comparable between the two groups. The study suggests that expanded lymphadenectomy may improve distant survival, but its effectiveness is limited by the risk of recurrence in the mediastinum or neck. The trial also highlights the need for further prospective randomized trials to evaluate the long-term benefits of expanded lymphadenectomy for thoracic esophageal cancer.A prospective randomized trial was conducted to evaluate the significance and issues of cervical upper mediastinal lymph node dissection (cervical upper mediastinal lymphadenectomy) for thoracic esophageal cancer. From January 1987 to December 1993, 71 patients with thoracic esophageal cancer met the inclusion criteria and were randomly assigned to either cervical upper mediastinal lymphadenectomy (expanded lymphadenectomy) or standard lymphadenectomy. The results showed that the expanded lymphadenectomy group had a lower lymph node metastasis rate in the upper mediastinum, particularly in nodes 105, right 106, and left 106. However, the survival rates at 2 and 5 years were 83.3% and 66.2% for the expanded group, compared to 64.8% and 48.0% for the standard group, with no statistically significant difference (p=0.192). The recurrence rate was lower in the expanded group (12.9% vs. 24.1%), with 3 out of 4 recurrences occurring in the mediastinum or neck. The expanded lymphadenectomy was associated with higher postoperative complications, including delayed recovery of cough reflex, higher incidence of recurrent laryngeal nerve palsy, and more frequent tracheostomy. However, the quality of life and postoperative survival were comparable between the two groups. The study suggests that expanded lymphadenectomy may improve distant survival, but its effectiveness is limited by the risk of recurrence in the mediastinum or neck. The trial also highlights the need for further prospective randomized trials to evaluate the long-term benefits of expanded lymphadenectomy for thoracic esophageal cancer.