P1.177. Supracarinal Lymph Nodal Dissection in Esophageal Squamous Cell Carcinoma Following Neoadjuvant Therapy

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer Accurate mediastinal staging remains pivotal to the management of esophageal carcinoma. While subcarinal and perigastric nodal basins are routinely evaluated, the prognostic and staging implications of supracarinal nodal involvement are less clearly defined. This study evaluates the incidence of metastasis to these stations in a contemporary esophagectomy cohort. An audit of a prospective database of esophagogastric cancers was conducted on 64 consecutive patients undergoing esophagectomy with total mediastinal lymphadenectomy for carcinoma esophagus. The data was analysed to determine nodal yield, anatomical distribution of nodal metastasis, and final pathological staging. The frequency and clinical associations of supracarinal nodal involvement were analyzed. Pathological nodal metastasis was identified in 18 patients (28.1%). 106 tbL nodal involvement occurred in 2 patients (3.1% overall; 11.1% of node-positive cases) and was uniformly associated with advanced nodal stage (N2/N3) and multi-station mediastinal disease. Tracheobronchial(106tbR) nodal metastasis was similarly observed in 2 patients (3.1% overall; 11.1% of node-positive cases), typically in conjunction with subcarinal or other mediastinal nodal involvement. No cases demonstrated isolated 106tbL or 106tbR metastasis. Median nodal harvest exceeded oncologic adequacy thresholds, supporting comprehensive mediastinal clearance. Although infrequent, metastasis to 106tbL or 106tbR nodal stations reflects advanced mediastinal dissemination and is associated with higher pathological nodal stage. Systematic dissection of these stations enhances staging accuracy. However, long term follow up is needed to assess oncological outcomes.