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Na et al. Mini-invasive Surg 2024;8:31 https://dx.doi.org/10.20517/2574-1225.2024.10 Page 3 of 12

Table 1. The efficacy index of each zone according to tumor location for esophageal SqCC
LN zone Upper esophageal cancer n = 629 Mid esophageal cancer n = 2,215 Lower esophageal cancer n = 983
Supraclavicular zone 14.1 9.2 5.3
Upper mediastinal zone 17.6 15.0 8.2
Middle mediastinal zone 3.0 6.1 4.7
Lower mediastinal zone 1.4 3.9 8.4
Perigastric zone 3.1 9.3 17.8
Celiac zone 0.0 1.0 2.9
[4]
This table is adapted from Tachimori et al. Esophagus. 2016;13:1-7. Springer Nature (https://doi.org/10.1007%2Fs10388-015-0515-3) under the
terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/). SqCC: Squamous cell
carcinoma; LN: lymph node.

Figure 1. LN groups according to the location of the tumor. (A) LN groups for tumor located in cervical area; (B) LN groups for tumor
located in upper thoracic area; (C) LN groups for tumor located in middle thoracic area; (D) LN groups for tumor located in lower
[6]
thoracic area. This figure is adapted from Japan Esophageal Society. Esophagus. 2017;14:1-36. Springer Nature (https://doi.org/10.
1007%2Fs10388-016-0551-7) under the terms of the Creative Commons Attribution 4.0 International License (http://
creativecommons.org/licenses/by/4.0/). LN: Lymph node.

their recommendations, regardless of the primary tumor’s location except abdominal area, the dissection of
both recurrent laryngeal LNs is advocated.

In the Japanese classification of esophageal cancer, 106recR refers to the right recurrent laryngeal LN, and
106recL designates the left recurrent laryngeal LN [Figure 2]. Additionally, 106tbL is also regarded as part of
the left recurrent laryngeal node. The inclusion of 106tbL in Group 2 varies among institutions, making the
decision to dissect this area dependent on each institute’s preference. In the American Joint Committee on
Cancer (AJCC) staging system, describing the location of recurrent laryngeal LNs is challenging, with
106recL corresponding to 2L and 4L in this system. However, there is no specified location for 106recR in
the AJCC system. At times, it is considered as 2R, but 2R denotes paratracheal LNs, indicating a distinct
location. Hence, I will describe the recurrent laryngeal LN as 106recR and 106recL in this article.

Recently, the Japanese Esophageal Society published the 12th edition of the Japanese Classification of
Esophageal Cancer. In this edition, N staging is categorized based on the number of LN metastases to align
with the AJCC/Union for International Cancer Control (UICC) system. However, the requirement for
dissection of both recurrent laryngeal LNs remains unchanged.