Objective To evaluate the usefulness of intraoperative pathological investigation of recurrent laryngeal nerve lymph nodes(RLN LN)metastasis in the decision-making of three-field lymphadenectomy(3FL)for thoracic esophageal cancers. Methods 100 patients with thoracic esophageal cancer were enrolled in a prospective study, in which 3FL was performed when RLN LN metastasis was revealed by intraoperative histological examination. For cases with negative RLN LN,two-field lymphadenectomy(2FL)was performed. The relationship between the RLN LN and cervical lymph nodes(CLN)was analyzed by collecting patient data. We also retrospectively analyzed medical records of 100 patients with esophageal cancer who underwent 3FL in our department as control group, focusing on LN status. We compared the survival and recurrence rates of CLN between the test group and control group. Results The CLN metastasis rate was higher whenthe RLN LN was metastasized. Multivariate analysis showed that RLN LN positive was an independent predictor of CLN metastasis, and the RLN LN did not result in ipsilateral CLN metastasis. The short-termpostoperative survival in thetest group was equivalent to that of the control group of 100 3FL patients when 3FL was the firstchoice for thoracic esophageal cancers, with fewer surgical complications. There was no significant difference in CLN recurrence. Conclusions Intraoperative histological diagnosis of RLN LN metastasis may help avoid unnecessary CLN resection.Bilateral CLN dissection should be recommended even if RLN LN metastasis is only unilateral. Selective 3FL can reduce the surgical complications and provideshort-termsurvival benefit like 3FL in certain patient subgroups.