Patient: Description of the condition (time of onset, main symptoms, hospital visited, etc.): Coarse lower esophagus and cardia with thickened wall and luminal narrowing. The surrounding space is poorly defined Multiple enlarged lymph nodes between the liver and stomach in the abdominal cavity, and calcified spots are seen under the right pleura. The lower esophagus is 36-43 cm from the incisors, with an infiltrative swelling, uneven surface, brittle texture, easy to bleed and stop bleeding on biting, mild luminal narrowing, invasion of the cardia, mucosal congestion and edema in the fundus, body and sinus, pylorus opening and closing freely, and no abnormalities in the duodenal bulb. Is my father in advanced stage? How long can I live without treatment? Doctor: Hello, your father’s condition is estimated to be in the middle to late stage, without treatment, he will not be able to eat soon and his prognosis is poor. Your father has lower esophageal cancer, metastasis to the abdominal cavity is the main cause. Most of the patients are in the middle to late stage when they visit the doctor like your father (this is the preoperative staging, not very accurate). However, after standardized comprehensive treatment, some patients can still survive for a long time. (Postoperative pathological staging is relatively accurate.) It is recommended that a detailed examination be performed, and if no metastases are found in the substantial organs, surgery-based comprehensive treatment can be considered. In cases like your father’s, most patients are treatable and worthy of treatment. Two cycles of preoperative neoadjuvant chemotherapy are recommended, followed by radical esophageal cancer surgery (second or third field lymphatic clearance) via the right upper thoracic abdomen. Patient: Doctor, thank you very much for giving me such a detailed answer in your busy schedule. On behalf of my family, I would like to thank you and wish you good luck in your work and peace in your life. Patient: Hello doctor, I would like to ask what is the second or third field lymphatic dissection and what kind of effect can be achieved? Doctor: Two-field lymph node dissection refers to the lymph nodes in the upper abdomen and the whole mediastinum, mainly the paracardia, the left gastric artery, the gastric lesser curvature, the common hepatic artery, the splenic artery, as well as the bilateral lymph nodes in the paraglottic nerve, the choroidal vein, the inferior ramus, the supra-diaphragm, the main bronchus, and the lower esophagus. The third-field clearance is the addition of cervical lymphatic clearance to the second-field clearance, mainly referring to the cervical esophageal-tracheal sulcus and supraclavicular lymph nodes. The greater the extent of clearance, the greater the five-year survival rate, but the probability of surgical complications also increases accordingly. The scope of surgery is determined by the test results and physical condition. Doctors: If the test results indicate advanced disease, chemotherapy is recommended before surgery. Pre-operative chemotherapy + surgery is better than surgery + post-operative chemotherapy. The surgery must be standardized (right dissection), not left dissection. Although left dissection is convenient, it is not only traumatic, but also ineffective, and is gradually being eliminated. However, it is still popular in most small and medium-sized hospitals in China, and its five-year survival rate is only 25-30%, which is close to the efficacy of non-surgical simultaneous radiotherapy. The five-year survival rate is only 25-30%, which is close to that of non-surgical simultaneous radiotherapy.