What type of study is this?

This is a Human Clinical Trial study.

September 10, 2025

Chemotherapy Combined With Immunotherapy Followed by Salvage Lymphadenectomy for Recurrence in Cervical Lymph Nodes After Esophagectomy: A Single-Center Prospective Study

Key Points

Salvage lymphadenectomy achieves R0 resection in 88.2% of patients treated with chemoimmunotherapy.
Grade III or higher adverse events occurred in 27.8% of patients, indicating significant risks involved.
The study assessed the impact of immunotherapy and chemotherapy on cervical node recurrences following esophagectomy.
Median recurrence-free survival and overall survival were recorded at 16.3 and 20.1 months, respectively.

Abstract

Abstract Background Patients diagnosed with esophageal squamous cell carcinoma (ESCC) experience a notably high rate of recurrence, even post-radical esophagectomy. Notably, recurrence localized in cervical lymph nodes presents an opportunity for potentially curative interventions; however, a consensus on optimal treatment strategies is currently lacking. The aim of this study is to evaluate the safety of salvage lymphadenectomy following chemoimmunotherapy, with the ultimate goal of informing and enhancing management strategies for patients experiencing recurrence in cervical lymph nodes after esophagectomy. Methods The preoperative chemoimmunotherapy regimen consisted of Carelizumab, nab-paclitaxel, and cisplatin, administered every three weeks for two cycles. An efficacy evaluation was conducted following this treatment; surgical intervention was considered if the disease met the criteria for resectability. The surgical procedures were carried out 3 to 6 weeks after the completion of the preoperative therapy. The primary endpoint of the study was the R0 resection rate, while secondary endpoints included the pathological complete response (pCR) rate, perioperative complications, recurrence-free survival (RFS), and overall survival (OS). Results A total of 18 patients were enrolled. Grade III or higher adverse events (AEs) occurred in 27.8% (5/18) of patients, with one individual died from immune-associated pneumonia. Ultimately, 17 patients proceeded to undergo salvage lymphadenectomy. R0 resection was successfully achieved in 88.2% (15/17) of these patients, accompanied by a pCR rate of 21.4% (3/14). No postoperative mortality was reported. With a median follow-up duration of 23 months (range 11–36 months), 3 patients experienced local recurrence in the neck, while 4 patients developed distal metastases. The median RFS and OS were recorded at 16.3 and 20.1 months, respectively. Conclusion Salvage lymphadenectomy following preoperative immunochemotherapy for recurrence in cervical lymph nodes presents as a promising radical treatment option. Extended follow-up is necessary to further clarify the long-term efficacy of this therapeutic approach.

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