Clinical Aspect: Esophageal Cancer

Abstract

Lymph node micrometastasis (LNM), including isolated tumor cells (ITC), has recently been the focus of study for the development of a biological method to detect lymph node metastasis in various malignant neoplasms. The applicability of immunohistochemistry (IHC) and reverse transcription-polymerase chain reactions (RT-PCR) to the detection of LNM in esophageal cancer has already been reported. However, the clinical significance of LNM currently remains unclear in patients with esophageal cancer. The presence of LNM is clinically important in patients without nodal metastasis in a routine histological examination (pN0) because patients with pN0, but also with LNM already exhibit metastatic potential. Accurate evaluations need to be performed using the same antibody or primer as well as the same technique in a large number of patients. A rapid diagnosis of LNM using IHC and RT-PCR during surgery will be clinically useful. Minimally invasive treatments such as endoscopic submucosal dissection and laparoscopic surgery with individualized lymphadenectomy are now being increasingly performed in consideration of postsurgical quality of life (QOL). However, it is important to maintain the balance between QOL and curability when selecting surgical treatments for patients with esophageal cancer. We reviewed the clinical significance of LNM as an important strategic target in patients with esophageal cancer.