Frontiers in Esophageal disease: lymph node metastatic patterns in esophageal cancer—first article in our new invited review series

In the current issue of Diseases of the Esophagus, we have the pleasure of publishing the first new series of premium-invited review articles. The series, which we have named Frontiers in Esophageal Disease, is intended to give our readership comprehensive reviews of the current most important areas of development or controversy in the esophageal world, written by the most important international opinion leaders. Our goal is that these articles will guide and inform our readership in the diverse and rapidly evolving field of esophagology.

This first article in the series, ‘Lymph node metastatic patterns and the development of multidisciplinary treatment for esophageal cancer’,¹ is written by Professor Yuko Kitagawa and his colleagues at Keio University, Tokyo, Japan. Professor Kitagawa’s group have pioneered research on lymph node metastatic patterns in esophageal cancer, first by exploring the sentinel node concept in gastric and esophageal cancer, and then by performing prospective studies mapping the patterns of lymph node metastasis in esophageal cancer of both histological subtypes.

Extended lymphadenectomy for gastric cancer, so-called D2 gastrectomy, was introduced in Japan after decades of research with meticulous mapping of lymph node metastatic patterns in relation to primary tumor characteristics. For gastric cancer, these patterns have been shown to be fairly predictable, and D2 gastrectomy is now considered to be evidence-based worldwide standard of care. The situation for esophageal cancer seems to be more complex and there is currently no consensus regarding the optimal lymphadenectomy for esophageal cancer. Interestingly, Mine and colleagues,² also from Japan, in 2012 showed that T1b and T2 tumors located on the ventral-left aspect of the esophagus drain into regional lymph node stations, whereas those located on the dorsal-right aspect mainly drain directly into the thoracic duct. The latter group, with less regional and more systemic drainage, which is likely to resemble the situation in circumferential T3–4 tumors, was shown to have a much worse survival.² Subsequent studies from Japan and elsewhere have been integrated into the current body of evidence, which is thoroughly discussed in the invited review article in this issue of Diseases of the Esophagus.

In the coming issues of DOTE, we have invited reviews in the series on the way, covering a number of very important topics. Among those planned in the coming issues are articles on artificial intelligence use in the diagnosis and staging of esophageal cancer, immunotherapy, oligometastatic disease, thoracic duct ligation versus preservation, and further also articles on reflux disease, achalasia and Barrett’s esophagus.

Editors-in-Chief of Diseases of the Esophagus

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