Relevance of Lymphadenectomy Extension to the Right Paratracheal Space in the Treatment of Esophagogastric Junction Adenocarcinoma

The benefit of extensive lymphadenectomy including the right paratracheal station (RPTS) in the upper mediastinum for esophagogastric junction (EGJ) adenocarcinoma remains controversial. Upper mediastinal lymph node (LN) involvement has been associated with esophageal invasion length, representing a potential research area. This study aimed to assess the rate of RPTS LN involvement in EGJ adenocarcinoma and its correlation with esophageal invasion length, as well as potential impacts on survival and postoperative complications. Patients undergoing two- or three-field esophagectomy with lymphadenectomy extended to the RPTS between 2006 and 2023 were retrospectively included. Patient, tumor, operative, and postoperative data were collected. Among 321 esophagectomies, 147 met inclusion criteria. Median esophageal invasion length was 3 cm. No patients (0%) had LN metastasis in the RPTS, regardless of invasion length (>4 cm or ≤4 cm). Postoperative complications occurred in 41.5% of patients, most commonly weight loss >10% (29.2%), pleural effusion (21.1%), and infectious pneumonitis (19.7%). Five-year overall and disease free survival rates were 44% and 29%, respectively. Our findings suggest that extending lymphadenectomy to the right paratracheal space fails to detect lymph node invasion in patients with esophageal invasion greater than or less than 4 cm in patients with esophageal adenocarcinoma.