Is robotic surgery meeting nodal benchmarks? AJCC and NCCN-based evaluation of lymph node yield and survival in robotic transhiatal esophagectomy.

BACKGROUND: Adequate lymph node (LN) retrieval is a key determinant of staging quality in esophageal cancer, with current guidelines recommending evaluation of at least 15 nodes. However, the relevance of this threshold in robotic transhiatal esophagectomy (THE) remains unclear. METHODS: We performed a retrospective analysis of a prospectively maintained single-center cohort of patients undergoing robotic THE for esophagogastric junction adenocarcinoma (2012-2024). Patients were stratified by LN yield (< 15 vs ≥ 15) according to AJCC and NCCN. Clinicopathologic variables, perioperative outcomes, disease-free survival (DFS), and overall survival (OS) were compared. Survival was assessed using Kaplan-Meier analysis. RESULTS: Eighty-four patients were included, with 56 (66.7%) in the < 15 LN group and 28 (33.3%) in the ≥ 15 LN group. Baseline characteristics were comparable. Higher LN yield was associated with increased lymphovascular invasion (32.1% vs 9.0%, p = 0.012) and a trend toward higher nodal positivity (50.0% vs 30.4%, p = 0.079). Perioperative outcomes, including complications and mortality, were similar between groups. Median follow-up was 47.8 months. Median DFS was 33.6 months in the < 15 LN group and 97.9 months in the ≥ 15 LN group (p = 0.430), while median OS was not reached and 97.9 months, respectively (p = 0.555). At 3 years, DFS (65% vs 49%) and OS (75% vs 56%) were numerically higher in the ≥ 15 LN group. CONCLUSIONS: Retrieval of ≥ 15 lymph nodes during robotic THE is associated with improved pathologic characterization without increasing perioperative morbidity. Although survival differences were not statistically significant, higher LN yield demonstrated a consistent trend toward improved outcomes, supporting its role as a quality metric in robotic esophagectomy.