TDLN-Guided Lymphadenectomy After Neoadjuvant Immunochemotherapy for ESCC

Inclusion Criteria: * Age 18 to 75 years, regardless of sex. * Eastern Cooperative Oncology Group performance status of 0 to 1. * Histologically confirmed thoracic esophageal squamous cell carcinoma. * Received neoadjuvant immunochemotherapy and considered suitable for curative surgery after multidisciplinary team evaluation. * Clinically resectable locally advanced or locally progressive disease without evidence of distant metastasis. * Completed preoperative contrast-enhanced computed tomography of the neck, chest, and abdomen. Positron emission tomography-computed tomography and/or endoscopic ultrasound may be performed if clinically available. * Considered by the investigator to be able to tolerate curative esophagectomy and standard systematic lymphadenectomy. Exclusion Criteria: * Non-squamous cell carcinoma histology or concurrent primary malignancy requiring treatment. * Previous curative surgery for esophageal cancer or previous radiotherapy for the current esophageal lesion. * Evidence of distant metastasis, unresectable disease, or considered unsuitable for curative surgery after multidisciplinary team evaluation. * Severe autoimmune disease requiring long-term systemic immunosuppressive therapy. * Severe cardiac, pulmonary, hepatic, renal, or other major organ dysfunction that prevents surgery or completion of study-related assessments. * Any other condition that, in the investigator's judgment, makes the participant unsuitable for the study, including poor compliance, inability to complete scheduled follow-up, or inability to provide key study data.