Do you electively cover the celiac axis in a patient with node negative middle third to distal, and GEJ esophageal carcinoma?

We do treat celiac axis nodes for distal esophagus and GE junction tumors along with the gastrohepatic nodal region for patients treated with a curative intent.

A surgical series of 462 consecutive patients treated with curative resection after chemoRT showed a celiac node metastasis in 15% of patients. Only 31% were identified on EUS/CT (not PET staged). Obviously PET will increase this sensitivity.

MDACC published their series of 131 patients treated with definitive chemoradiation for esophageal cancer.

There were 6/60 (10%) celiac failures in those not covered, 5 of which were first site of recurrence and difficult to manage

There were 5/71 (7%) celiac failures in those who were covered. They did not see increase toxicity.

Based on the limited data we have I think it is reasonable to include it.

Lymph node metastases near the celiac trunk should be considered separately from other nodal metastases ...