Objective:To determine the effects of clavicle-lifting strategy as a part of radical 3 field lymphadenectomy for patients with esophageal cancer on survival. Summary Background Data: Removal of bilateral recurrent nerve nodes in upper mediastinallesion and cervical lesion as 3-field lymphadenectomy was reported to improve prognosis in esophageal cancer, which is still in debate. Methods:To dissect cervical and upper thoracic lymph nodes thoroughly and safely,we created a clavicle-lifting technique, which can extend the operative field around the subclavicular space by lifting the clavicle upward with a pediatric extension retractor. The endpoint was defined as death due to progression of esophageal cancer. Results:Without increasing morbidity/mortality, patients treated with clavicle lifting (n=35) survived significantly longer than those treated with 2-field lymphadenectomy(n=163)(P=0.0116), even after multivariate adjustment for cancer stage, calendar year of surgery, and the use of chemoradiotherapy (Hazard Ratio: 0.11 95%CI 0.01-0.84 P=0.033). Moreover, patients treated with clavicle lifting (n=30) were survived longer than stage and surgery-matched patients treated with 2-field lymphadenectomy(n=30)(P=0.0073),even after multivariate adjustment (Hazard Ratio:0.06;95%CI:0.01-0.50;P=0.009). In addition,clavicle lifting significantly decreased the risk of cervical and thoracic lymph node metastasis (P=0.024), but not abdominal lymph node and vascular metastasis. Conclusions: These results suggest that the clavicle-lifting strategy may allow a more thorough dissection of cervical and upper thoracic lymph nodes, without increasing morbidity/mortality, and may improve prognosis of patients with esophageal cancer by reducing lymphatic metastasis.