The Relevance of Lymphadenectomy Extension to the Right Paratracheal Space in the Treatment of Esophagogastric Junction Adenocarcinoma: A Retrospective Bicentric Study
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".