Lymph Node Dissection of the Upper Mediastinum in Distal Oesophageal and Oesophagogastric Junction Cancer: Indicated in All Patients? Review.
The role of upper mediastinal lymph node dissection (UMLND) in distal oesophageal and oesophagogastric junction (AEG) cancers remains debated, requiring a balance between potential oncologic benefit and surgical risk. This review provides an updated perspective on its role.
We analysed current evidence from retrospective studies, meta-analyses, and ongoing clinical trials, focusing on histology, tumour location, staging, neoadjuvant therapy response, and surgical outcomes.
Routine UMLND is not supported for all distal oesophageal and AEG cancers. A standard 2-field dissection is sufficient for most patients with AEG adenocarcinoma. Extended 2-field dissection may be beneficial for squamous cell carcinoma of the upper and middle oesophagus and for adenocarcinoma with high-risk features, such as clinically positive upper mediastinal nodes or bulky abdominal/low-mid-mediastinal nodes. Current evidence highlights the need for a tailored surgical approach rather than uniform application.
UMLND should not be considered routine but applied selectively according to tumour biology, location, and response to multimodal therapy. Future randomized data, particularly incorporating immunotherapy and advanced imaging and surgical techniques, will better define the optimal extent of lymphadenectomy in distinct patient subgroups.
We analysed current evidence from retrospective studies, meta-analyses, and ongoing clinical trials, focusing on histology, tumour location, staging, neoadjuvant therapy response, and surgical outcomes.
Routine UMLND is not supported for all distal oesophageal and AEG cancers. A standard 2-field dissection is sufficient for most patients with AEG adenocarcinoma. Extended 2-field dissection may be beneficial for squamous cell carcinoma of the upper and middle oesophagus and for adenocarcinoma with high-risk features, such as clinically positive upper mediastinal nodes or bulky abdominal/low-mid-mediastinal nodes. Current evidence highlights the need for a tailored surgical approach rather than uniform application.
UMLND should not be considered routine but applied selectively according to tumour biology, location, and response to multimodal therapy. Future randomized data, particularly incorporating immunotherapy and advanced imaging and surgical techniques, will better define the optimal extent of lymphadenectomy in distinct patient subgroups.
Authors
Meier Adamenko Meier Adamenko, Lozanovski Lozanovski, Ehrsam Ehrsam, Grimminger Grimminger, Schneider Schneider
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