Clinical staging is an important reference for treatment decisions and a key factor affecting the prognosis of patients. As one of the most important international staging criteria, the 12 th edition of classification of esophageal cancer of Japan Esophageal Society (JES) has been applied in clinical practice since 2022. Compared with the previous classification of esophageal cancer of JES, the N staging in 12 th edition of classification of esophageal cancer is defined as the number of lymph node metastases, rather than the station of the metastatic lymph nodes according to the tumor location. It is noteworthy that the 12 th edition of classification of esophageal cancer classifies supraclavicular lymph nodes as M1a stage, and M1a stage as well as N2-N3 stages are classified in the same clinical stage, which means that the Japanese scholars still believe that supraclavicular lymph node metastasis is not a contraindication to surgery for thoracic esophageal cancer. Compared with the esophageal cancer staging criteria jointly issued by the International Anti-Cancer Alliance and the American Cancer Federation, it is controversial that whether esophageal cancer patients with supraclavicular lymph node metastasis can receive surgical treatment. Since esophageal squamous cell carcinoma in China is the main pathological type as in Japan, a clear understanding and answer to the above question is of great significance in guiding the clinical diagnosis and treatment of esophageal cancer. The authors consult relevant literature and combine it with clinical practice to explore the controversy of supraclavicular lymph node metastasis in the treatment of esophageal cancer, aiming to provide reference for the accurate definition of metastatic lymph nodes in esophageal cancer, as well as the precise staging and optimal treatment mode for patients.

Clinical staging is an important reference for treatment decisions and a key factor affecting the prognosis of patients. As one of the most important international staging criteria, the 12 th edition of classification of esophageal cancer of Japan Esophageal Society (JES) has been applied in clinical practice since 2022. Compared with the previous classification of esophageal cancer of JES, the N staging in 12 th edition of classification of esophageal cancer is defined as the number of lymph node metastases, rather than the station of the metastatic lymph nodes according to the tumor location. It is noteworthy that the 12 th edition of classification of esophageal cancer classifies supraclavicular lymph nodes as M1a stage, and M1a stage as well as N2-N3 stages are classified in the same clinical stage, which means that the Japanese scholars still believe that supraclavicular lymph node metastasis is not a contraindication to surgery for thoracic esophageal cancer. Compared with the esophageal cancer staging criteria jointly issued by the International Anti-Cancer Alliance and the American Cancer Federation, it is controversial that whether esophageal cancer patients with supraclavicular lymph node metastasis can receive surgical treatment. Since esophageal squamous cell carcinoma in China is the main pathological type as in Japan, a clear understanding and answer to the above question is of great significance in guiding the clinical diagnosis and treatment of esophageal cancer. The authors consult relevant literature and combine it with clinical practice to explore the controversy of supraclavicular lymph node metastasis in the treatment of esophageal cancer, aiming to provide reference for the accurate definition of metastatic lymph nodes in esophageal cancer, as well as the precise staging and optimal treatment mode for patients.

Esophageal cancer surgery originated in the early 20^th century. However, the true meaning of trans-thoracic esophagectomy and digestive tract reconstruction began in the 1930s. Almost at the same time, Japan and Western countries began the surgical exploration of esophageal cancer. Based on the pathological type of esophageal cancer in Asia, squamous cell carcinoma is the majority, and its biological characteristics and treatment strategies are different from those of European and American patients. After more than eighty years of development, the surgical treatment of esophageal cancer in Japan has been developed from the initial attempt, deep cultivation practice to the pursuit of excellence, and explored a set of more advanced surgical techniques and diagnostic strategies, which is unique in the world. On the basis of the establishment of the Japanese Society of Esophagus, Japanese scholars have developed and irregularly updated the Japanese Classification of Esophageal Cancer and published the professional academic journal Esophagus. The Japanese Clinical Oncology Group organized a number of phase Ⅲ clinical studies on esophageal cancer, providing strong evidence for the diagnosis and treatment of esophageal squamous carcinoma. Focused on the origin, development, current situation and future of esophageal cancer surgery in Japan, this paper summarized the development of esophageal cancer surgery in Japan through literature review, interviews with senior experts and Hot topics of esophageal cancer surgery-questionnaire survey of Japanese experts.

Purpose: This study aimed at identifying difficulties among post thoracic esophagectomy cancer patients during outpatient follow-up. Methods: Patients who had radical esophagectomy at a cancer center hospital in Japan were prospectively observed and were interviewed by a certified nurse assigned at esophageal surgical outpatient division. Their responses were documented in medical records and were analyzed by content analysis method. This study was approved by the study hospital's research ethics committee. Results: The data from 66 patients were obtained. Content analysis yielded 221 extracts, 25 categories, and 65 codes of difficulties, including: concerns or signs/symptoms associated with dietary intake, physical activity, and anxiety. Implications: The majority of post-thoracoabdominal esophagectomy patients experienced multiple dysfunctions and symptoms after discharge. The results underscore the significance of nurses' role in assessing and instructing patients to address these issues.

Background: Patients having thoracic esophagectomy, a standardized treatment for esophageal cancer patients in Japan, are known to have various postsurgical signs and symptoms for a period of time. The current status of nursing interventions at outpatients need to be clarified. Purpose: This study aimed at identifying the nurses' interventions for cancer patients at the outpatient setting who previously had thoracic radical esophagectomy. Methods: Patients who had esophagectomy at a cancer center hospital in Japan were prospectively observed and interviewed by outpatient nurses between January 2009 and December 2010. Their documented responses in medical record were prospectively investigated and were qualitatively analyzed via content analysis method. This study was approved by the study hospital's research ethics committee. Results and discussion: The data analysis of nursing interventions for 66 patients yielded 372 extracts, 12 categories, and 74 codes. Nurses were assessing patients' signs and symptoms affected by postsurgical changes, and were utilizing patients' active self-monitoring skills. The results also showed the significance of facilitating postsurgical recovery in relation to nutritional intake and physical activity in patients' daily life. Implications: Based upon the study results, the development of a systematic program is underway, which facilitates esophageal cancer patients' postsurgical recovery.