Noordman BJ, et al. - The authors aimed at comparing overall survival in patients with esophageal adenocarcinoma who underwent transhiatal esophagectomy (THE) with limited lymphadenectomy or transthoracic esophagectomy (TTE) with extended lymphadenectomy with or without neoadjuvant chemoradiotherapy (nCRT). TTE showed differential effects on survival, with a more favorable prognostic effect in patients who were treated with surgery alone, this was particularly evident in a subgroup of patients with 1 to 8 positive lymph nodes in the resection specimen. The favorable prognostic effect of TTE over THE was absent in the nCRT and surgery group and in the subgroup of nCRT patients with 1 to 8 positive lymph nodes in the resection specimen. Observations thereby suggest that the addition of nCRT, compared to surgery alone, may reduce the necessity for TTE with extended lymphadenectomy to improve long-term survival in patients with esophageal adenocarcinoma.