Establishing a standard surgery for esophagogastric junction cancer: Final results from the JGCA-JES nationwide prospective study

The optimal surgical approach and extent of lymph node dissection for esophagogastric junction (EGJ) cancer remains uncertain. We conduct a nationwide multicenter prospective study in patients with resectable cT2–T4 adenocarcinoma or squamous cell carcinoma with the tumor epicenter located within 2 cm of the EGJ. Patients undergo subtotal or lower esophagectomy with dissection of all regional lymph nodes. Of 1,065 patients screened, 371 are enrolled before surgery. Final analysis shows that proximal perigastric and suprapancreatic nodes exhibit a high therapeutic efficacy index (TEI), strongly supporting their dissection for improved long-term survival. TEIs in middle and lower para-esophageal stations are higher when esophageal involvement exceeds 3 and 2 cm, respectively. Conversely, all other stations, including distal perigastric and paraaortic nodes, have low TEIs, indicating minimal survival impact. Thus, mediastinal node dissection should be tailored to esophageal involvement length. This study is registered at UMIN Clinical Trials Registry (UMIN000013205). • Abdominal station nos. 1, 2, 3, 7, 9, and 11p show high TEIs • TEIs in mediastinal station nos. 108 and 110 increase with esophageal involvement • All other nodes, including distal perigastric and paraaortic nodes, show low TEIs • Lymphadenectomy should be tailored to esophageal involvement length in EGJ cancer Kurokawa et al. examine the therapeutic efficacy index (TEI) across all regional lymph nodes in esophagogastric junction cancer using a nationwide multicenter prospective study. Proximal perigastric and suprapancreatic nodes show a high TEI, whereas TEIs in middle and lower para-esophageal stations vary according to the length of esophageal involvement.