The increasing incidence of adenocarcinoma of the esophagogastric junction (AEG) has gained worldwide concern in recent years. The lymph node metastasis of AEG presents bidirectional pattern. When the esophageal invasion length in Siewert II and III AEG is more than 2 cm, the lower mediastinal lymph node dissection is required; when the esophageal invasion length is less than 4 cm, the operation can be performed effectively and safely by transhiatal approach. Employing the infracardiac bursa as an anatomical landmark can help the accurate dissection of the lower mediastinal lymph nodes; the concept of total mesenteric excision can improve the clearance rate of the lower mediastinal lymph nodes and improve the oncological safety.