Characteristics of Lymph Node Metastasis in Esophageal Squamous-Cell Carcinoma Undergoing Upfront Minimally Invasive Esophagectomy: A Prospective Surgical Cohort Study

Pham, Binh Van; Nguyen, Duy Duc; Thai, An Duc

doi:10.31557/APJCP.2026.27.5.1689

Characteristics of Lymph Node Metastasis in Esophageal Squamous-Cell Carcinoma Undergoing Upfront Minimally Invasive Esophagectomy: A Prospective Surgical Cohort Study

Document Type : Research Articles

Authors

Department of Digestive Surgery 1, Vietnam National Cancer Hospital, Vietnam.

10.31557/APJCP.2026.27.5.1689

Abstract

Introduction: This study aims to evaluate the characteristics of lymph node metastasis (LNM) in patients with early esophageal squamous cell carcinoma (ESCC) undergoing upfront minimally invasive esophagectomy and extended two-field lymph node dissection. Patients and methods: This prospective study was conducted from October 2022 to May 2024. All patients with early esophageal squamous cell carcinoma (ESCC) who underwent minimally invasive esophagectomy and extended two-field lymph node dissection were selected for this study. Postoperative lymph nodes were divided into the upper thoracic, middle thoracic, lower thoracic, and abdominal lymph node groups. Univariate and multivariable logistic regression analyses were performed to identify risk factors associated with lymph node metastasis (LNM). Disease-free survival (DFS) was assessed using the Kaplan–Meier method. Results: The overall rate of LNM was 30%, with increasing incidence by pathological T stage: 14.3% in pT1a, 32.1% in pT1b, and 50% in pT2. LNM was most frequently observed in upper thoracic and abdominal lymph node groups. Univariate analysis identified poor differentiation, lymphovascular/perineural invasion (LVI/PNI), tumor size >2 cm, and increased esophageal wall thickness on endoscopic ultrasound as significant risk factors. However, in multivariable analysis, only tumor size >2 cm remained independently associated with LNM (OR 5.47; 95% CI: 1.05–32.65; p = 0.04). Patients without LNM had significantly longer DFS compared to those with LNM (22.4 vs. 14.5 months; p = 0.003). Conclusion: Lymph node metastasis can occur even in early-stage esophageal squamous cell carcinoma. Poor differentiation, lymphovascular/perineural invasion, tumor size >2 cm, and esophageal wall thickness on endoscopic ultrasound were identified as independent prognostic factors for lymph node metastasis.

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