ArticleAnnals of surgical oncology2026
Patterns of Lymph Node Metastases After Multimodality Therapy in Esophageal Carcinoma Treated with Robot-Assisted Minimally Invasive Esophagectomy (RAMIE).
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLymph 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.
methodsA 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.
resultsAmong 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.
conclusionsLymphatic 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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