Understaging of esophageal tumors can be expected mostly for upper-third lesions, since an incomplete node dissection is usually performed in the upper mediastinum and the neck. This may result in a worse prognosis. The three-field lymphadenectomy is proposed for tumors located above the carina, in patients at low operative risk, younger than 70 years, when a R-O resection is feasible. This approach allows an accurate staging of the disease and a more realistic prediction of survival. Prospective studies are needed to identify the subset of patients who can benefit from this approach in terms of long-term survival.