Prognostic significance of subcarinal lymph node involvement in patients with Siewert type I and II gastro-esophageal junctional adenocarcinoma: an analysis of 698 patients undergoing Ivor-Lewis esophagectomy.

Gastro-esophageal junction (GOJ) adenocarcinoma is increasingly common and despite significant changes in management over the past decade, overall survival remains poor. Determining factors that influence survival is important for optimizing curative surgery. The prognostic significance of subcarinal lymph node involvement is unclear. The purpose of this study was to assess the prognostic significance of subcarinal lymph node involvement in patients undergoing curative resection of GOJ adenocarcinoma. Consecutive patients undergoing curative 2-stage Ivor-Lewis esophagectomy between February 2010 and January 2022 were analyzed retrospectively from a prospectively maintained database for Siewert type I and II GOJ adenocarcinoma confirmed on histopathology. Outcomes were compared based on subcarinal node involvement confirmed on histopathology. A total of 698 patients with Siewert type I (n = 314) and II (n = 384) adenocarcinoma were analyzed [median age 68 (31-85), 604 males (87%) neo-adjuvant use 491 (74.4%)]. Eighteen patients (2.6%) had subcarinal lymph node involvement. These patients had more advanced overall stage of disease and positive node involvement than those without and a significantly lower median survival of 6 months (<1-25) compared to 53 months (41-65) (p < 0.001). On multivariate analysis, pathological T stage, para-gastric and subcarinal lymph node involvement were found to be the independent and significant factors influencing survival. Subcarinal lymph node involvement is an indicator of advanced disease and high positive node burden. It is an independent prognostic factor in patients undergoing curative surgery for Siewert type I and II GOJ adenocarcinoma.