This operative video demonstrates a robotic staging laparoscopy and celiac axis lymphadenectomy performed for oligoprogressive metastatic esophageal squamous cell carcinoma.

The patient is a 61-year-old man with HER2-negative, PD-L1 CPS 2 moderately differentiated squamous cell carcinoma of the mid esophagus who initially underwent definitive chemoradiation with weekly carboplatin and paclitaxel.

During treatment the patient developed severe dysphagia and inability to tolerate oral intake, requiring placement of a robotic feeding jejunostomy with subsequent revision for obstruction.

Restaging imaging following chemoradiation unfortunately demonstrated metastatic disease, and the patient was not a candidate for curative esophagectomy. He underwent palliative esophageal stenting and continued systemic therapy with an overall mixed response.

Over time the patient experienced substantial tumor regression and improvement in symptoms, allowing removal of his feeding jejunostomy. However, surveillance imaging demonstrated persistent progression within gastroesophageal and celiac axis lymph nodes while the remainder of disease remained controlled.

Following multidisciplinary discussion, the patient was referred for surgical resection of this limited site of progressionas a palliative disease-control strategy.

The patient underwent robotic staging laparoscopy and celiac axis lymphadenectomy.

Intraoperative findings demonstrated:

• Bulky lymph nodes along the left gastric artery and celiac axis

• No evidence of additional intra-abdominal metastatic disease

The pars flaccida was opened, allowing exposure of the left gastric artery and celiac axis. The left gastric artery and vein were ligated, and the celiac lymph node packet was dissected from the splenic artery, lesser curvature of the stomach, gastroesophageal junction, diaphragmatic crura, and retroperitoneum.

The specimen was removed in an EndoCatch retrieval bag.

The patient tolerated the procedure well and was discharged home the following day.

Final pathology demonstrated:

• Metastatic keratinizing squamous cell carcinoma

• 1 of 3 celiac lymph nodes involved with tumor

This case illustrates the use of robotic minimally invasive lymphadenectomy for oligoprogressive metastatic disease, performed as a palliative intervention aimed at achieving regional disease control during ongoing systemic therapy.