The extent of lymphadenectomy in esophageal cancer surgery is a point of controversy at present, although the most recent evidence shows that survival is directly related to the number of nodes removed during surgery. Descriptive study of patients with esophageal neoplasia who underwent esophagectomy with extended and total mediastinal lymphadenectomy by minimally invasive approach (right prone thoracoscopy, laparoscopy and left cervicotomy) in our center from January 2019 to December 2021. The data of patients included were retrospectively examined. Extended lymphadenectomy was indicated in patients with distal third adenocarcinoma type tumors while total lymphadenectomy was indicated in patient with squamous tumors and middle third adenocarcinoma. The primary endpoint was the incidence of affected lymph nodes in the upper mediastinum based on pathological examination. The secondary endpoint was to analyze the short-term outcomes. A total of 45 patients were included (26.7% extended and 73.3% total mediastinal lymphadenectomy). The median number of removed nodes was 2 (IQR 4–1) and 2 (IQR 3–1) in the right and left recurrent area, respectively. Overall, the median incidence of recurrent lymph node metastases was 11.1%. Twenty percent of the patients with adenocarcinoma (100% distal third) and 0% of the patients with squamous cell carcinoma had positive recurrent nodes. Ninety-day mortality was 15.6%. With respect to postoperative complications such as recurrent laryngeal nerve paralysis was present in 24.4%. Anastomotic leakage was present in 20% (4.4% thoracic and 15.6% cervical). Based on our results, extended and total lymphadenectomy increases both the overall number of lymph nodes removed and the number of affected nodes. This prevalence of positive recurrent nodes is not negligible. This greater radicality is associated with significant morbidity. The results of this study support the performance of extended lymphadenectomies also in distal third adenocarcinomas.