The 13th International Congress of Esophageal Diseases was held in Venice, Italy, from October 15 to 17. As the highest level of international academic conference in the field of esophageal diseases, this conference was attended by more than 700 scholars from more than 40 countries and regions around the world, and included more than 700 abstracts. The conference covers all aspects of basic and clinical research on benign esophageal diseases and esophageal tumors, including: Barrett’s esophagus, esophageal motor dysfunction, esophageal mucosal sensitivity and hypersensitivity, gastroesophageal reflux disease, esophageal hiatal hernia, medical esophageal disease, pediatric esophageal disease, new techniques in esophageal surgery, and esophageal function monitoring. Esophageal cancer research and discussion took up a considerable part of the conference. Scholars from different countries in the East and West reported new theories, methods and techniques in the field of esophageal cancer and reached consensus on some issues through lively discussions. The International Society for Diseases of the Esophagus (ISDE) was re-elected at this meeting, and Jan Tack, a specialist in gastroenterology at the University of Leuven, Belgium, was elected. Professor Jan Tack completed his term as President of ISDE and Professor Peters Jeffrey of the Department of Thoracic Surgery, University of Rochester, USA, completed his term as President of ISDE. The 14th International Congress of Esophageal Diseases will be held in Vancouver, Canada in September 2014. It is noteworthy that ISDE is willing to hold the 15th International Congress of Esophageal Diseases in China in 2016 with the active efforts of Chinese scholars. (there are more than 100 delegates from Japan). The congress hopes to fully communicate with more Chinese scholars, not only specialists in esophageal surgery, but also researchers related to gastroenterology, medical oncology, radiology, endoscopy and basic research. As a country with a high incidence of esophageal cancer, we have huge research resources and practitioners, and we should really make enough efforts to welcome this event with excellent clinical and research results and a more positive attitude to change the dominance of Japan as an Asian country in international conferences on esophageal diseases. Application and improvement of the TNM staging of esophageal cancer The 7th edition of the international TNM staging of esophageal cancer was implemented in 2010, and several papers worldwide have already reported on the use of the new TNM staging and suggested many improvements. In this conference, Professor Rice, head of the International TNM Staging of Esophageal Cancer project and professor of Cleveland Medical Center, analyzed the possible improvements of the next edition (8th edition) of TNM staging. He believes that the biggest shortcoming of the current TNM staging of esophageal cancer is that all information is derived from esophagectomy cases only, and the development of preoperative clinical staging (cStage), post-neoadjuvant clinical staging, post-radiotherapy clinical staging for non-surgical patients (ycStage), and post-neoadjuvant pathological staging (ypStage) are future research directions, and these improvements rely on collecting more These improvements depend on the collection of more case data and the establishment of a large database. Secondly, the 7th edition of TNM staging introduces “non-anatomical” indicators such as tumor pathological type (adenosquamous/squamous carcinoma) and degree of differentiation, which is also a trend of TNM staging improvement and will include more “non-anatomical” indicators that can affect prognosis. In the future, esophageal cancer staging will be based on individual analysis, forming a judgment model and a prognostic model. The former will decide the next treatment plan based on clinical stage and other individual indicators, while the latter will achieve accurate prediction of individual prognosis based on pathological stage and patient indicators. New methods and techniques for esophageal cancer treatment Endoscopic resection of esophageal cancer includes endoscopic mucosal resection and endoscopic submucosal dissection (ESD). Endoscopic determination of the depth of early esophageal cancer invasion is crucial to the choice of endoscopic resection (Figure). Muto (Muto) et al. at the University of Tokyo, Japan, considered the prospect of ESD combined with radiotherapy for stage I esophageal cancer to be of interest. Takahashi, Saku Central Hospital, Japan, reported long-term survival results in patients after ESD for early-stage esophageal squamous carcinoma, with an R0 resection rate of up to 95%, the most common complication being mediastinal emphysema (3%), and no esophageal perforation or hemorrhage; the incidence of postoperative esophageal stricture was extremely high if the resection extended beyond the 3/4 circumference of the esophagus. Van der Sleis, University Medical Center Utrecht, The Netherlands Van der Sluis presented the experience of 108 cases of robotic-assisted lumpectomy for esophageal cancer, with a mean operative time of 399 minutes (360-550 minutes) and a mean blood loss of 590 ml; the postoperative pulmonary complication rate was 35.5%, the anastomotic fistula rate was 18%, and the postoperative in-hospital mortality rate was 4.5%, suggesting that robotic-assisted The study suggests that robotic-assisted esophageal cancer resection is safe and effective. Similar results were reported by Philip W. Y. Chiu of the Chinese University of Hong Kong. The long-term prognosis for patients with esophageal cancer has been discouraging, and despite advances in a range of surgical techniques and oncologic options, the 5-year survival rate for patients with esophageal cancer is still difficult to exceed 35%. In the author’s opinion, under the premise that surgery is the mainstay, the treatment of esophageal cancer should eventually take the path of multidisciplinary combined treatment. A multicenter randomized controlled clinical study in the Netherlands found that there was no difference in the postoperative complication rate between neoadjuvant radiotherapy combined with surgery for esophageal cancer and surgery alone, and the R0 resection rate in the neoadjuvant group was significantly higher than that in the surgery alone group (92% vs. 69%), and there was a significant difference in the postoperative 5-year survival rate between the two groups (47% vs. 34%); the investigators also concluded that neoadjuvant radiotherapy combined with radical resection is The investigators also concluded that neoadjuvant radiotherapy combined with radical resection is the standard of care for resectable intermediate to advanced esophageal cancer. It should be noted that Kinjo, a scholar at the University of the Ryukyus, Japan, suggested that patients who respond to neoadjuvant radiotherapy should still be aggressively cleared of lymph nodes intraoperatively. The data showed that lymph node micrometastasis was still observed in patients who responded to neoadjuvant therapy; lymph node micrometastasis was not necessarily associated with the degree of patient response to neoadjuvant therapy. Basic research on molecular biology of esophageal cancer As mentioned earlier, more “non-anatomical” indicators may be added to the TNM staging of esophageal cancer in the future, and some biomarkers based on molecular biology may also be incorporated into the new TNM staging system. The Dutch scholar Prins et al. reported that 14.2% of patients with esophageal adenocarcinoma had overexpression of Her2/neu gene and 19.1% had Her2/neu gene amplification. Their findings emphasize the importance of performing Her2/neu gene testing, as this subset of patients could benefit from trastuzumab treatment. A research team led by Prof. Lidong Wang of Zhengzhou University identified the esophageal cancer susceptibility genes C20orf54 and PLCE1 in the Chinese population through a genome-wide association study, the results of which were published in Nature Genetics in 2010. A conference presentation on further research progress on C20orf54 by Associate Professor Ai-Fang Ji from Changzhi Medical College, Shanxi Province, showed that genetic susceptibility plays a crucial role in the formation of esophageal cancer and that C20orf54 functional single nucleotide polymorphism (SNP) is associated with risk of esophageal squamous cancer. Scholars at the University of Padova, Italy, who examined esophageal squamous cell carcinoma antigen (SCCA) expression in esophageal/esophageal cancer tissues from Barrett’s esophagus, esophageal adenocarcinoma, esophageal squamous carcinoma, and control normal subjects, found that this antigen was most highly expressed in esophageal cancer, followed by Barrett’s esophagus, all of which were significantly higher than normal controls. Therefore, gastroscopic biopsy to monitor SCCA expression levels in patients with esophageal reflux disease can help to screen out “high-risk” cases and enhance surveillance. Comparison of East-West Esophageal Cancer Research A special session on “Diagnosis and Treatment of Esophageal Squamous Carcinoma: East-West Comparison” was held at the conference, and experts from Germany, Hong Kong, China and Japan were invited to present. German scholars presented two of the most important guidelines for the treatment of esophageal cancer in Western countries, namely the National Comprehensive Cancer Network (NCCN) guidelines and the European Society of Medical Oncology (ESMO) guidelines. The latest version of the NCCN guidelines recommends that surgery remains the first choice for patients with early-stage (stage I-II) non-cervical esophageal cancer; the treatment of choice for cervical esophageal cancer is radical radiotherapy regimens (radiotherapy dose: 50.4 Gy); and preoperative neoadjuvant radiotherapy (radiotherapy dose: 45-50.4 Gy) should be considered for patients with locally advanced esophageal cancer. . Japanese scholars presented the study of the anterior lymph nodes of esophageal cancer. The distribution of lymphatic transit in the esophagus is extensive from the neck to the upper abdomen, which determines the complexity and diversity of lymph node metastasis in esophageal cancer. Imaging of the lymphatic system formed by preoperative radiographic techniques for localization of the anterior lymph can help guide the extent of intraoperative lymph node dissection.