TDLN-Guided Lymphadenectomy After Neoadjuvant Immunochemotherapy for ESCC

Inclusion Criteria:

• Age 18 to 75 years, regardless of sex.
• Eastern Cooperative Oncology Group performance status of 0 to 1.
• Histologically confirmed thoracic esophageal squamous cell carcinoma.
• Received neoadjuvant immunochemotherapy and considered suitable for curative surgery after multidisciplinary team evaluation.
• Clinically resectable locally advanced or locally progressive disease without evidence of distant metastasis.
• Completed preoperative contrast-enhanced computed tomography of the neck, chest, and abdomen. Positron emission tomography-computed tomography and/or endoscopic ultrasound may be performed if clinically available.
• Considered by the investigator to be able to tolerate curative esophagectomy and standard systematic lymphadenectomy.

Exclusion Criteria:

• Non-squamous cell carcinoma histology or concurrent primary malignancy requiring treatment.
• Previous curative surgery for esophageal cancer or previous radiotherapy for the current esophageal lesion.
• Evidence of distant metastasis, unresectable disease, or considered unsuitable for curative surgery after multidisciplinary team evaluation.
• Severe autoimmune disease requiring long-term systemic immunosuppressive therapy.
• Severe cardiac, pulmonary, hepatic, renal, or other major organ dysfunction that prevents surgery or completion of study-related assessments.
• Any other condition that, in the investigator's judgment, makes the participant unsuitable for the study, including poor compliance, inability to complete scheduled follow-up, or inability to provide key study data.