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Because tumor\u2010draining lymph nodes serve as key hubs of anti\u2010tumor immunity, this study evaluated how prior lymphadenectomy or nodal irradiation influences subsequent ICI outcomes. We retrospectively analyzed 507 patients, including 302 with recurrent esophageal squamous cell carcinoma after surgery or radiotherapy and 205 with treatment\u2010na\u00efve advanced disease, all treated with ICI\u2010based regimens. In the postoperative recurrence group, an optimal lymph node yield range emerged. Patients with 16\u201322 dissected lymph nodes (DLNs) achieved significantly longer progression\u2010free survival (PFS; 12.20\u2009months) than those with \u226416 DLNs (7.17\u2009months) or &gt;22 DLNs (6.37\u2009months). DLN group remained an independent prognostic factor for PFS in multivariate analysis. Among patients with post\u2010radiotherapy recurrence, prior involved\u2010field irradiation correlated with significantly longer PFS than elective nodal irradiation (8.30 vs. 5.10\u2009months). These findings suggest an association between prior lymphatic intervention and PFS in patients receiving immunotherapy. A moderate extent of lymphadenectomy and the use of IFI were associated with improved PFS. These results underscore the importance of carefully balancing locoregional disease management with preservation of lymphatic immune architecture in the immunotherapy era.<\/jats:p>","DOI":"10.1002\/ijc.70459","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T04:40:16Z","timestamp":1774327216000},"page":"924-935","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of lymphatic ablation approaches on immunotherapy efficacy in advanced\/metastatic esophageal squamous cell carcinoma: A multi\u2010institutional retrospective cohort study"],"prefix":"10.1002","volume":"159","author":[{"given":"Yingxin","family":"Liu","sequence":"first","affiliation":[{"name":"Shandong University Cancer Center, Cheeloo College of Medicine Shandong University  Jinan Shandong China"},{"name":"Department of Radiation Oncology, Shandong Cancer Hospital and Institute Shandong First Medical University, 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