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Esophageal Cancer Research and Treatment / Gastric Cancer Management and Outcomes / Head and Neck Cancer Studies · Journal article
Annals of Surgical Oncology · August 12, 2026
Early or partial results. Treat as a signal, not a conclusion.
This prospective single-centre mapping study documents the distribution of residual lymph node metastases across anatomical stations in 210 patients with esophageal cancer treated with robot-assisted minimally invasive esophagectomy and two-field lymphadenectomy. Despite 91% receiving neoadjuvant therapy, 42% retained nodal disease, with widespread distribution across mediastinal, paraesophageal, and abdominal stations; the authors argue this persistence justifies systematic two-field lymphadenectomy for staging and locoregional control.
Prospective single-centre observational cohort study. Patients with esophageal adenocarcinoma or squamous cell carcinoma treated with transthoracic RAMIE at a single centre, 2018–2024. No explicit eligibility criteria, contraindications, or exclusions reported.. Intervention: Transthoracic robot-assisted minimally invasive esophagectomy (RAMIE) with two-field lymphadenectomy. n = 210. Single centre (not specified).
Among 210 patients, 42% had lymph node metastases with median 2 positive nodes (IQR 1–4) Median lymph node yield was 44 nodes (IQR 34–52) Most frequent metastasis sites: left gastric artery nodes (22%), right paracardial nodes (15%), paraesophageal stations (11%), subcarinal stations (10%)
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The high frequency of residual nodal disease (42%) and occult disease in cN0 patients (32%) after neoadjuvant therapy supports the continued use of systematic two-field lymphadenectomy for accurate staging and locoregional control in esophageal cancer. However, the study provides descriptive mapping only and does not quantify whether this lymphadenectomy pattern affects survival or recurrence outcomes.
Single-centre prospective observational cohort with descriptive analysis of lymph node distribution patterns; no comparator group, no hypothesis testing, and no clinical outcome data reported.
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The high frequency of residual nodal disease (42%) and occult disease in cN0 patients (32%) after neoadjuvant therapy supports the continued use of systematic two-field lymphadenectomy for accurate staging and locoregional control in esophageal cancer. However, the study provides descriptive mapping only and does not quantify whether this lymphadenectomy pattern affects survival or recurrence outcomes.
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Abstract Background Lymph node metastases (LNMs) in esophageal carcinoma demonstrate extensive and variable dissemination. Previous mapping studies are limited to region-based reporting, heterogeneous classification systems, and absence of contemporary multimodality-treated cohorts. This study aimed to characterize the station-level distribution of LNMs after standardized robot-assisted minimally invasive transthoracic esophagectomy (RAMIE) with two-field lymphadenectomy and to evaluate patterns in relation to key preoperative parameters. Methods A prospective, single-center observational cohort of patients undergoing transthoracic RAMIE for adenocarcinoma (AC) or squamous cell carcinoma (SCC) between 2018 and 2024 was analyzed. The primary outcome was station-level distribution of LNMs in relation to histology, tumor location, clinical T stage, clinical N stage, and receipt of neoadjuvant therapy. Analyses were descriptive. Results Among 210 patients (74% AC, 26% SCC), median lymph node yield was 44 (interquartile range [IQR], 34–52). Lymph node metastases were present in 42% of the patients, with a median of two positive nodes (IQR, 1–4). Although 91% received neoadjuvant therapy (85% CROSS, 7% FLOT), residual nodal disease remained frequent and widely distributed. Metastases occurred most frequently in the paraesophageal (11%) subcarinal (10%) mediastinal stations, and along the left gastric artery (22%) and right paracardial (15%) nodes. Thoracic duct LNM was identified in 9% of the patients. Patterns were similar across preoperative parameters. Occult nodal disease was observed in 32% of cN0 patients. Conclusions Lymphatic dissemination in esophageal cancer remains extensive and unpredictable, even after multimodality therapy. The persistence of cross-diaphragmatic nodal involvement across subgroups underscores the ongoing necessity of a systematic two-field lymphadenectomy to achieve optimal locoregional control and accurate pathologic staging.
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