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The sentinel node (SN) concept has revolutionized the surgical staging of both melanoma and breast cancer over the past two decades. The application of this concept can yield benefits for patients by preventing various complications related to unnecessary prophylactic regional lymph node dissection in patients with cancer-negative SNs. Clinical application of SN mapping in patients with early gastric cancer has been a controversial issue for years. However, a recent meta-analysis and a prospective multicenter trial of SN mapping for early gastric cancer have shown acceptable SN detection rates and accuracy of determination of lymph node status. For early stage gastric cancer such as cT1N0M0, for which a better prognosis can be achieved through conventional surgical approaches, the establishment of individualized, minimally invasive treatments that may retain the patients’ quality of life should be the next surgical challenge. Although there are many unresolved technical issues, laparoscopic SN biopsy with laparoscopic minimized gastrectomy or endoscopic mucosal resection/endoscopic submucosal dissection has the potential to achieve this goal.

Purpose This study aimed to compare short-term outcomes of minimally invasive esophagectomy (MIE) with those of open esophagectomy (OE) for thoracic esophageal cancer using a nationwide Japanese database. Methods Overall, 9584 patients with thoracic esophageal cancer who underwent esophagectomy at 864 hospitals in 2011–2012 were evaluated. We performed one-to-one matching between the MIE and OE groups on the basis of estimated propensity scores for each patient. Results After propensity score matching, operative time was significantly longer in the MIE group ( n  = 3515) than in the OE group ( n  = 3515) [526 ± 149 vs. 461 ± 156 min, p  < 0.001], whereas blood loss was markedly less in the MIE group than in the OE group (442 ± 612l vs. 608 ± 591 ml, p  < 0.001). The populations of patients who required more than 48 h of postoperative respiratory ventilation was significantly less in the MIE group than in the OE group (8.9 vs. 10.9%, p  = 0.006); however, reoperation rate within 30 days was significantly higher in the MIE group than in the OE group (7.0 vs. 5.3%, p  = 0.004). There were no significant differences between the MIE and OE groups in 30-day mortality rates (0.9 vs. 1.1%) and operative mortality rates (2.5 vs. 2.8%, respectively). Conclusions MIE was comparable with conventional OE in terms of short-term outcome after esophagectomy. It was particularly beneficial in reducing postoperative respiratory complications, but may be associated with higher reoperation rates.

Recently, minimally invasive (endoscopic or laparoscopic) treatment for early gastric cancer (EGC) has been widely accepted. However, a standard gastrectomy with radical lymphadenectomy is generally performed in patients with EGC who have no indications for endoscopic resection, and postgastrectomy dysfunction is one of the problems of standard gastrectomy. Function-preserving gastrectomy, such as proximal gastrectomy and pylorus-preserving gastrectomy, can be considered when attempting to preserve the patient’s quality of life (QOL) postoperatively. In addition, sentinel node navigation surgery for EGC has been applied in clinical practice in several prospective studies on function-preserving personalized minimized gastrectomy. In the near future, the sentinel lymph node concept is expected to form the basis for establishing an ideal, personalized, minimally invasive function-preserving treatment for patients with EGC, which will improve their postoperative QOL without compromising their long-term survival. In this review article, we summarize the current status, surgical techniques, and postoperative outcomes of function-preserving gastrectomy for EGC.

Conversion therapy, defined as curative‐intent surgery or chemoradiotherapy after induction therapy, is gaining attention in patients with initially unresectable esophageal squamous cell carcinoma due to adjacent organ invasion (cT4b) or distant metastasis (M1). This systematic review aimed to assess survival outcomes, treatment strategies, and the evolving role of immune checkpoint inhibitors in this context. PubMed, Embase, and the Cochrane Library were comprehensively searched to identify studies published between 2010 and 2025 that reported conversion therapy outcomes in patients with esophageal squamous cell carcinoma with cT4b or M1. This review included 15 studies. A 2019 systematic review established the foundation for current practice in cT4b. Subsequent retrospective and prospective studies have reported 5‐year overall survival rates of up to 51.6% in patients undergoing salvage or conversion surgery, with no residual tumor (R0) resection rates reaching 98.9% in extended procedures. The ongoing JCOG1510 phase III trial is expected to clarify the optimal strategy. Selected patients undergoing conversion surgery for M1 after induction therapy achieved a 5‐year overall survival of 31.7%, with an R0 resection rate of 87%. Survival was not significantly associated with the metastatic site or treatment modality, highlighting the importance of treatment response and multidisciplinary decision‐making. The incorporation of immune checkpoint inhibitors into induction regimens expands the pool of candidates eligible for curative‐intent local therapy. Conversion therapy may provide durable survival in carefully selected patients, and further prospective studies are warranted to refine patient selection and establish standardized treatment algorithms. We systematically reviewed conversion therapy for esophageal squamous cell carcinoma and propose a response‐based treatment strategy for cT4b and M1 disease. For cT4b, we emphasize definitive chemoradiotherapy with timed re‐evaluation and selective salvage or chemoselection to surgery; for M1, conversion is reserved for limited‐burden responders with sustained systemic control (ctDNA‐guided when available), targeting R0 resection or definitive local control.

PurposeRisk stratification to select appropriate candidates for adjuvant therapy is required for esophageal cancer patients based on adjuvant therapy advancement including immunotherapy. The current study aims to develop a novel staging system using pathological stage (pStage) and response to neoadjuvant chemotherapy (NAC) for esophageal squamous cell carcinoma (ESCC).MethodsESCC patients who received NAC and underwent transthoracic esophagectomy at two Japanese high-volume esophageal centers were retrospectively reviewed. The prognostic value of NAC response was evaluated within the same pStage, and a novel risk stratification to predict cancer-specific survival (CSS) was developed.ResultsThe HR (95% CI) of pathological responders in pStage 0–I, II, III, and IV was 0.29 (0.07–1.17), 0.37 (0.12–1.10), 0.37 (0.15–0.92), and 0.24 (0.06–0.98), respectively. Responders in pStage 0–II were classified to be in the same class and those in pStage III/IV in another group, because the 5-year CSS (5y-CSS) rate of responders in pStage 0–I, II, III, and IV was 94%, 92%, 76%, and 71%, respectively. Combining nonresponders in pStage 0–II as the same group, all patients were subdivided into five groups. Intriguingly, the 5y-CSS in pStage III–IV responders was 75%, almost identical to that of nonresponders in pStage 0–II (78%).ConclusionsThe histological response influenced the long-term outcomes of patients who underwent esophagectomy after NAC, even within groups stratified by pathologic stage. The current risk stratification system will contribute to selecting appropriate candidates for adjuvant therapy.

Thoracic esophagectomy is a particularly invasive and complicated surgical procedure, with a reconstruction of the gastrointestinal tract, such as the stomach, jejunum, or colon. The posterior mediastinal, retrosternal, and subcutaneous routes are the three possible esophageal reconstruction routes. Each route has advantages and disadvantages, and the optimal reconstruction route after esophagectomy remains controversial. Additionally, the best anastomotic techniques after esophagectomy in terms of location (Ivor Lewis or McKeown) and suturing (manual or mechanical) are debatable. Our meta‐analysis investigating postoperative complications after esophagectomy between the posterior mediastinal and retrosternal routes revealed that the posterior mediastinal route was associated with a significantly lower anastomotic leakage rate than the retrosternal route (odds ratio = 0.78, 95% confidence interval: 0.70–0.87, p < 0.0001). Conversely, pulmonary complications (odds ratio = 0.80, 95% confidence interval: 0.58–1.11, p = 0.19) and mortality between the posterior mediastinal and retrosternal routes (odds ratio = 0.79, 95% confidence interval: 0.56–1.12, p = 0.19) were not significantly different. However, the incidence of pneumonia may be lower when using the retrosternal route rather than the posterior mediastinal route for performing minimally invasive esophagectomy. The McKeown procedure is oncologically necessary for tumors located above the carina to dissect upper mediastinal and cervical lymph nodes; however, the Ivor Lewis procedure offers perioperative and oncological safety for tumors located under the carina. An individualized treatment strategy for selecting the optimal reconstruction procedure can be proposed in future studies based on oncological and patient risk factors considering mid‐ to long‐term quality of life. Anastomotic leakage was significantly less in the posterior mediastinal route, and the incidence of pneumonia was significantly lower in the retrosternal route in MIE. In the future, an individualized treatment strategy for selecting the optimal reconstruction procedure can be proposed based on oncological and patient risk factors considering mid‐ to long‐term QOL.

Background We aimed to present the 2019 annual report of the gastroenterological section of the National Clinical Database (NCD). Methods We reviewed 609,589 cases recorded in 2019 and 5,029,764 cases registered from 2011 to 2019 for the 115 selected gastroenterological surgical procedures. Results The main features of gastroenterological surgery in Japan were similar to those described in the 2018 annual report, namely, that 1) operative numbers gradually increased in all procedures, except gastrectomy and hepatectomy, which decreased in these years; 2) in all eight major gastroenterological surgeries, the age distribution tended toward older patients; 3) the morbidity of esophagectomy, hepatectomy, and pancreaticoduodenectomy increased, but mortality was minimized in all procedures; 4) all eight major gastroenterological procedures have increasingly been performed under laparoscopy; and 5) board‐certified surgeons were increasingly involved. These trends in recent years were more prominent in 2019. Conclusions Thanks to the continuous cooperation and dedication of the surgeons, medical staff, and surgical clinical reviewers who registered the clinical data into the NCD, it is possible to understand the comprehensive landscape of surgery in Japan and to disclose new evidence in this field. The Japanese Society of Gastroenterological Surgery will continue to promote the value of this database and encourage the use of feedback and clinical studies using the NCD, now and in the future. Generating further approaches to surgical quality improvement are important directions for future research. As the annual report of NCD 2019, data of gastroenterological surgery from 2011 to 2019 in Japan were summarized, and the trends in the 115 gastroenterological procedures and eight major gastroenterological surgeries were reported.