Background: The extent of lymph node dissection can affect tumor node metastasis staging. The resulting “stage migration” might hamper stage-by-stage comparison between different forms of oesophageal resection. Methods: Between 1992 and 2004, 368 patients with resectable carcinomas of the oesophagus underwent esophagectomy. Subtotal esophagectomy was performed either by thoracoabdominal (150 patients, 40.8%) or by transhiatal approach (218 patients, 59.2%). Results: According to the regional lymph node (LN) yield the patients were divided in three groups (6 or lower, 7 to 18 and 19 and more). No significant overall survival differences were identified between the groups when comparing patients with nodal involvement (pN1). Focusing only on pN0-patients, the median overall survival (MOS) of those operated on transhiatally was 33 (≤6 LN), 43 (7-18 LN, n.s. vs. group 1), and 84 months (≥19 LN, p=0.0190 vs. 0-6; p=0.0203 vs. 7-18 LN). MOS of patients operated on through a thoracoabdominal approach was 8 (≤6 LN), 15 (7-18 LN, n.s. vs. group 1), and 63 months (≥19 LN, p=0.0005 vs. 0-6; p=0.0131 vs. 7-18 LN). The median ratio of positive lymph nodes during thoracoabdominal resection was 6% versus 10% for the transhiatal procedure (chi square=0.001). According the ratio of positive lymph nodes, the patients were divided in four groups (without positive, 0-11%, 11-33%, and 33% and more). Considering only the transhiatal approach, the patients could be, in fact, divided into 2 groups, below and above 11%, since there were no statistical differences between other groups (below vs. above 11% log rank<0.0001). On contrary, in patients operated on by a thoracoabdominal approach, patients with 33% and more positive lymph nodes had a significantly worse 5-year overall survival probability than those of the other 3 groups (w/o positive log rank=0.0001; 0-11% log rank=0.001; and 11-33% log rank=0.005). Conclusions: Recommended regional LN yield from the UICC for oesophageal carcinoma (6 LN) is neither reliable for correct staging of the disease nor provides curative benefits for the patients. Evidence of lymph node metastases indicates that a generalized disease is present which can no longer be influenced by local, surgical measures.