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Introduction The prognosis of gastroesophageal junction adenocarcinoma is unquestionably related to the extent of nodal involvement. Not only the amount of positive lymph nodes but also the location of postive nodes negatively influence survival. Earlier small studies revealed a poor survival for patients with positive nodes in the proximal field of the chest when treated with surgery alone. It is thus far unknown what the relevance of these nodes is after neoadjuvant therapy. The aim of the present study was to identify the incidence and prognostic significance of lymph node metastases in the proximal part of the chest in patients who underwent a transthoracic oesophagectomy after neoadjuvant therapy. Method From a prospectively collected database, a consecutive series of patients in two high volume centres in Europe was analysed. All patients with potentially curable adeno carcinoma of the gastro-oesophageal junction were treated with neoadjuvant chemo (radiation)therapy therapy followed by transthoracic oesophagectomy and two-field lymphadenectomy. Results Between January 2000 and September 2013 a consecutive series of 208 patients underwent an oesophagectomy after neoadjuvant therapy for adenocarcinoma of the gastro-oesophageal junction. 80 (38.5%) patients had no evidence of lymph node metastases (N0). There were 128 patients (61.5%) with positive nodes (N1=41 (19.7%), N2=44 (21.2%), N3=43 (20.7%)). Of the node positive patients, 25 (19.5%) had positive nodes in the proximal field of the chest (paratracheal, subcarinal, bronchial and aorto-pulmonary window lymph nodes). More advanced N-stage was significantly associated with positive nodes in the proximal field of the chest (p Conclusion Lymph node metastases in the proximal part of the chest in patients is a common phenomonemon and a sign of advanced disease. Radical surgical resection can only be achieved with an extended transthoracic resection. Even after neoadjuvant therapy followed by transthoracic resection long-term survival is poor. Disclosure of interest None Declared.

Introduction In patients with oesophageal cancer, little attention has been paid to the biological significance of extracapsular lymph node involvement (LNI) in patients who underwent neoadjuvant treatment followed by oesophagectomy. Therefore, the aim of the present study was to assess the incidence, extent of extracapsular LNI and prognostic significance in a consecutive multicenter series of patients with cancer of the oesophagus or gastro-esophageal junction (GOJ) who underwent neoadjuvant chemo (radio) therapy followed by surgery. Method From a prospectively collected database, a consecutive series of patients in two high volume centres in Europe was analysed. All patients with potentially curable adeno- or squamous cell carcinoma of the oesophagus or GOJ were treated with neoadjuvant chemotherapy or chemoradiation therapy followed by transthoracic oesophagectomy and two-field lymphadenectomy. Results Between January 2000 and September 2013 a consecutive series of 704 patients underwent an oesophagectomy after neoadjuvant therapy. A median number of 28 (5–77) nodes was resected and identified. 347 (49.3%) patients had no evidence of lymph node metastases (ypN0). There were 357 (50.7%) patients with positive nodes (ypN1-N3). Extracapsular LNI was identified in 190 (53.2%) of lymph node positive patients. Five-year overall survival rates were 63% for N0 patients, 45% for patients with intracapsular LNI and 14% for patients with extracapsular LNI (p Conclusion The presence of extracapsular LNI after neoadjuvant chemo (radiation) therapy identifies a subgroup of patients with a significantly worse long-term survival. Extracapsular LNI reflects a particularly aggressive biologic behaviour and has significant prognostic potential and should be considered for the future edition of the TNM staging system for oesophageal cancer. Disclosure of interest None Declared.