Recent advances in surgical robotic systems, high-speed communication networks, and information processing technologies have made the clinical implementation of remote surgery increasingly feasible. Although pilot clinical applications have been initiated worldwide, the safe, ethical, and sustainable adoption of remote surgery requires comprehensive guidance that addresses not only technical considerations, but also clinical practice, legal responsibility, and organizational frameworks. In response to these needs, the Japan Surgical Society has developed the second edition of the Clinical Practice Guidelines for Telesurgery through a multidisciplinary, consensus-based process involving multiple surgical societies. This updated edition builds on validation and verification studies conducted since the publication of the first edition and places particular emphasis on practical implementation in real-world clinical settings, including telesurgical support and telementoring. The guidelines provide expanded, implementation-oriented recommendations covering surgeon and support staff qualifications, institutional requirements, communication network performance and cybersecurity standards, registry-based governance, and structured approaches to remote surgical mentoring. In addition, legal and ethical considerations are strengthened through the inclusion of representative informed consent documents and contractual frameworks. To enhance international applicability, content that is broadly relevant across jurisdictions is presented separately from elements specific to the Japanese regulatory environment. These guidelines aim to support the responsible global dissemination of telesurgery by promoting safety, transparency, and clinical effectiveness.

Circulating tumor DNA (ctDNA) testing in patients with colorectal cancer (CRC) has demonstrated clinical significance in various contexts, including post-curative resection. Therefore, we developed a predictive model integrating preoperative ctDNA levels with radiographic imaging to assess the risk of postoperative recurrence in patients with CRC. Patients with CRC from the GALAXY study with either newly diagnosed or recurrent, curatively resectable liver or lung metastases were enrolled between May 2020 and December 2022, and radiographic images were collected between February 2023 and January 2025. The ratio of preoperative ctDNA levels to tumor metastasis volume from radiographic imaging, ctDNA levels alone, and tumor volume alone was assessed. Overall, 181 and 48 patients from the GALAXY trial had liver and lung metastases, respectively. Among patients with liver metastases, the median progression-free survival (PFS) was 11.4 and 24 months in the high- and low-risk groups classified by the ctDNA model, respectively. Among patients with lung metastases, the median PFS was 12 months and not reached in the high- and low-risk groups classified by the ctDNA/volume model, respectively. Conclusively, incorporating radiological markers of necrosis and refining the tumor volume estimation may further improve model accuracy in liver metastasis settings.

BACKGROUND/OBJECTIVES:Currently, a definitive diagnostic strategy for predicting mediastinal lymph-node (MLN) metastasis remains poorly established in Siewert Type I and II esophagogastric junction adenocarcinoma (EGJAC). This study aimed to evaluate long-term survival and identify objective, reliable preoperative risk factors for MLN metastasis to optimize perioperative treatment and surgical approach. METHODS:We retrospectively reviewed a well-defined cohort of 133 patients with Siewert Type I (33.1%) and II (66.9%) EGJAC who underwent R0 resection and complete follow-up at our institution between 2005 and 2025. Preoperative risk factors for histological MLN metastasis were evaluated using receiver operating characteristic (ROC) curve analysis and univariate/multivariate logistic regression models. RESULTS:Thorough upper, middle, and lower MLND were completed in 57.9%, 72.9%, and 94.7% of patients, respectively. Pathological MLN metastasis was confirmed in 31.6% of patients and was significantly associated with poor overall and recurrence-free survival. ROC analysis demonstrated that an MLN short-axis diameter of ≥5 mm on CT, esophageal involvement length (EIL) in upper GI series ≥ 30 mm, and EIL in endoscopy ≥ 60 mm predict histological MLN metastasis. In univariate analysis, Siewert Type I, EIL in upper GI series ≥30 mm, EIL in endoscopy ≥ 60 mm, clinical tumor depth ≥ cT3, and CT node size ≥ 5 mm were correlated with MLN metastasis. Multivariate logistic regression analysis revealed that a clinical tumor depth of ≥cT3, EIL in upper GI series ≥ 30 mm, and a CT node size of ≥5 mm were independent predictors of MLN metastasis. CONCLUSIONS:Clinical tumor depth, EIL, and size of MLN are powerful independent preoperative risk factors for MLN metastasis in Siewert Type I/II EGJAC. Utilizing these objective indices may help identify high-risk patients requiring intensive perioperative multidisciplinary strategies.

Recent advances in surgical robotic systems, high-speed communication networks, and information processing technologies have made the clinical implementation of remote surgery increasingly feasible. Although pilot clinical applications have been initiated worldwide, the safe, ethical, and sustainable adoption of remote surgery requires comprehensive guidance that addresses not only technical considerations, but also clinical practice, legal responsibility, and organizational frameworks. In response to these needs, the Japan Surgical Society has developed the second edition of the Clinical Practice Guidelines for Telesurgery through a multidisciplinary, consensus-based process involving multiple surgical societies. This updated edition builds on validation and verification studies conducted since the publication of the first edition and places particular emphasis on practical implementation in real-world clinical settings, including telesurgical support and telementoring. The guidelines provide expanded, implementation-oriented recommendations covering surgeon and support staff qualifications, institutional requirements, communication network performance and cybersecurity standards, registry-based governance, and structured approaches to remote surgical mentoring. In addition, legal and ethical considerations are strengthened through the inclusion of representative informed consent documents and contractual frameworks. To enhance international applicability, content that is broadly relevant across jurisdictions is presented separately from elements specific to the Japanese regulatory environment. These guidelines aim to support the responsible global dissemination of telesurgery by promoting safety, transparency, and clinical effectiveness.

BACKGROUND:This study aimed to clarify the correlation between anastomotic leakage and anastomotic position after esophagectomy for esophageal cancer, stratified by gastric conduit blood flow assessed using indocyanine green (ICG) fluorescence imaging. METHODS:A total of 136 patients who underwent esophagectomy with retrosternal gastric conduit reconstruction were included. After creating the gastric conduit, three points were identified: point A (anastomotic site), point B (terminal end of the gastroepiploic artery stained with ICG), and point C (terminal end of the gastric conduit wall stained with ICG). Anastomotic position was defined by the relative location of point A between points B and C, and blood flow speed before reconstruction (pre-speed) was quantified using ICG fluorescence imaging. Associations of anastomotic position and pre-speed with anastomotic leakage were evaluated. RESULTS:Anastomotic leakage occurred in 22 patients (16.2%). Mean distance BA (point B to A) was 2.05 cm in the leakage group and 0.15 cm in the non-leakage group (p = 0.018). Mean distance AC (point A to C) was 4.00 cm in the leakage group and 5.89 cm in the non-leakage group (p = 0.016). Logistic regression revealed that BA > -0.50 cm and pre-speed < 2.19 cm/s were independent risk factors for anastomotic leakage (odds ratio 4.67, p = 0.046, and odds ratio 56.16, p < 0.001, respectively). Among patients with delayed blood flow, the anastomotic leakage rate was significantly lower in the proximal group than in the distal group (p = 0.034). CONCLUSIONS:ICG fluorescence imaging provides useful information for determining an appropriate anastomotic position. Performing the anastomosis at a more proximal site within the gastric conduit may reduce the risk of anastomotic leakage.

Surgeries can improve the quality of life and save the lives of patients, which telementoring could help with when on-site expert surgeons are unavailable. The prevalence of laparoscopic and robotic surgery has led to increasing attention on telementoring, which involves real-time, remote, intraoperative image-based guidance from surgeons. However, the communication tools and equipment used can cause significantly various quality of telementoring, and no clear consensus exists; brief image shifts can cause miscommunication between local and remote surgeons. This study aimed to develop a novel system to improve the reliability of telementoring. We developed a novel real-time image-tracking annotation system (RITAS) using the MedianFlow algorithm, an object-tracking algorithm available as an external module within the OpenCV image-processing library. Using this system, three laparoscopic surgeries were performed at Beppu Hospital with telementoring support from Kyushu University. Surgical videos were transmitted through a secured optical fiber network, and a remote mentor annotated the video using a tablet device. These annotations tracked the surgical field and were simultaneously sent back to Beppu Hospital, allowing the local surgeon to refer to them during the procedure. One of the three RITAS-based telementoring sessions was conducted under a blinded protocol in which the tracking feature was alternately enabled and disabled every 10 min to assess annotation effectiveness. In this exploratory interval-level analysis, RITAS showed a higher effective annotation rate than non-tracking annotation. All three RITAS-based laparoscopic surgeries were completed without observed intraoperative or postoperative complications. In this pilot technical feasibility study, RITAS was clinically implemented in laparoscopic telementoring and showed improved annotation stability compared with non-tracking annotation in a preliminary blinded comparison. Further studies are required to evaluate technical robustness, usability, educational value, safety, and clinical impact.

Esophageal adenosquamous carcinoma is a rare histological subtype of esophageal cancer characterized by the coexistence of squamous cell carcinoma and adenocarcinoma components. Preoperative diagnosis is challenging because biopsy specimens often contain only the squamous component. A 75-year-old man presented with dysphagia. Esophagogastroduodenoscopy revealed a type 3 tumor in the middle thoracic esophagus. Histopathological examination of the biopsy specimens demonstrated predominantly squamous cell carcinoma with a minor mucin-producing adenocarcinoma component, raising suspicion of adenosquamous carcinoma. Given the patient’s history of myocardial infarction and poor cardiac function, neoadjuvant chemotherapy was considered unsuitable. The patient underwent thoracoscopic esophagectomy with lymph node dissection. Pathological examination confirmed adenosquamous carcinoma, with the superficial portion composed predominantly of moderately differentiated squamous cell carcinoma, whereas the deeper layers contained mucinous carcinoma and signet-ring cells. Extensive lymph node metastases were identified in the cervical, thoracic, and abdominal regions, the majority of which predominantly comprised mucinous carcinoma. At seven months postoperatively, mediastinal lymph node recurrence was detected. Due to the patient’s deteriorating general condition, systemic chemotherapy was contraindicated, and the patient died 11 months postoperatively. We report a rare case of esophageal adenosquamous carcinoma with mucinous carcinoma-predominant lymph node metastases. The predominance of mucinous carcinoma in metastatic lesions may reflect the aggressive biological behavior of the adenocarcinoma component and could be associated with poor clinical outcomes. Although esophageal adenosquamous carcinoma is generally managed using surgery-based multidisciplinary strategies based on the treatment principles for esophageal squamous cell carcinoma, no standard chemotherapy regimen has been established for esophageal adenosquamous carcinoma. Further accumulation of cases is needed to determine the optimal treatment strategies for this rare disease.

ABSTRACT Despite recent advances in multimodal management, pancreatic ductal adenocarcinoma remains a fatal malignancy. Early detection of indirect findings of pancreatic ductal adenocarcinoma is essential to improve treatment outcomes, drawing attention to pancreatic parenchymal atrophy. Pancreatic parenchymal atrophy, defined as the narrowing of the parenchyma below a line connecting the cephalic and caudal margins of the lesion on computed tomography, can predict early‐stage pancreatic ductal adenocarcinoma and its intraductal extension. Computed tomography with three‐directional imaging is the ideal initial modality for diagnosing pancreatic parenchymal atrophy. In patients with early pancreatic ductal adenocarcinoma, pancreatic parenchymal atrophy exhibits a significantly longer intraductal lateral tumor extension. Pancreatic parenchymal atrophy can be resected using an appropriate‐margin pancreatectomy with a low risk of positive surgical margins. However, the appropriate surgical margin length for each case remains unclear. Carcinoma in situ may be present only within a focal pancreatic parenchymal atrophy region, and pancreatic duct changes may not be present. For such patients, a surgical strategy of limited pancreatectomy with a smaller surgical margin, combined with additional intraoperative resection based on frozen‐section results, is acceptable. Although the relationship between carcinoma in situ and fatty replacement of the pancreatic parenchyma has been investigated, the underlying mechanism remains unclear.

INTRODUCTION:In recent years, the practical application of remote robotic surgery has become a reality, and is expected to be applied to difficult surgeries. The purpose of this study is to demonstrate whether the pancreaticojejunostomy in a pancreaticoduodenectomy, a difficult surgery, can be performed through a remote surgery-assisted robotic operation, as well as to verify the feasibility of remote surgery-assisted pancreaticojejunostomy. METHODS:Hirosaki city and Goshogawara city (about 30 km) were connected via a commercial communication line using the hinotori surgical robot, and five surgeons performed remote surgery on an artificial organ model for pancreaticojejunostomy. Four local surgeons were instructed remotely. Each procedure was repeated 3-5 times in sets of 8 min, and communication latency, Image Quality Score, System Usability Scale (mSUS), and Robot Usability Score were all evaluated. RESULTS:The communication latency was stable at less than 12 msec, and there were no problems in performing the surgery. No significant differences were noted in Image Quality Score, System Usability Scale (mSUS), or Robot Usability Score. Pancreaticojejunostomy was performed using the Blumgart anastomosis technique, and all procedures were completed without any issues. CONCLUSION:We demonstrated that pancreaticojejunostomy can be performed in a telesurgical environment. This system can be applied to remote surgical guidance and support in the future and it is expected to correct regional disparities in medical care, improve surgical education, and enhance the implementation of remote surgery in society.

Multidisciplinary treatments for advanced rectal cancer are diverse. Neoadjuvant chemoradiation therapy (nCRT) is a total neoadjuvant therapy treatment option. Some studies have reported that tumor-infiltrating lymphocytes (TILs) and inflammatory blood factors [(neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune inflammatory index (SII)] are predictors of nCRT efficacy. However, the relationship between changes in TILs and inflammatory blood factors during nCRT and the resulting tumor regression grade (TRG) remains unclear. In this study, we investigated whether changes in TILs and inflammatory blood factors during nCRT were related to TRG. We retrospectively studied 196 patients with rectal cancer who underwent curative resection after nCRT for advanced rectal cancer. Immunohistochemical staining of lymphocyte surface markers, including CD3, CD4, and CD8, was performed on biopsy specimens before and during nCRT. Inflammatory blood factors were assessed using blood samples collected before treatment and seven days after the initiation of nCRT. Changes in CD4 levels were related to TRG. NLR and SII during nCRT were associated with TRG. TRG tended to be better in patients with values below the cut-off. The NLR during nCRT and changes in NLR, PLR, and SII were associated with the tumor shrinkage rate. Changes in PLR were related to TRG. There was no relationship between TIL, peripheral blood changes, and recurrence rate. It was suggested that changes in CD4+ TILs immediately after treatment initiation and changes in inflammatory blood factors during treatment may be useful for predicting the reduction rate and TRG. These changes begin early during treatment and may be useful in predicting efficacy.

ABSTRACT Aim This study evaluated the short‐term outcomes of low anterior resection for rectal cancer in Japan before and after the COVID‐19 pandemic, with a particular focus on the timing of its reclassification within Japan in May 2023. Methods Using data from the Japanese National Clinical Database, we analyzed 109 754 low anterior resection cases between January 2018 and December 2023, categorized into pre‐pandemic (February 2020 and earlier), pandemic (March 2020–April 2023), and post‐pandemic (May 2023 onward) periods. Trends in the number of low anterior resection cases, postoperative intensive care unit utilization, and complications, including anastomotic leakage and pneumonia, were examined. Standardized morbidity ratios were used to adjust for risk and assess trends over time. Results The number of low anterior resection cases declined during the pandemic but returned to pre‐pandemic levels thereafter. The postoperative intensive care unit admission rates remained stable, with a slight increase post‐pandemic. The incidence of major complications gradually declined from pre‐pandemic to post‐pandemic, with anastomotic leakage rates decreasing from 9.8% to 7.1% and the standardized morbidity ratio for anastomotic leakage decreasing from 1.0 to 0.8, reflecting improved outcomes. The number of robot‐assisted surgeries significantly increased from 246 cases in March 2020 to 535 in May 2023, and their proportion among total surgeries also rose from 16.8% to 41.2%. Conclusion Despite initial challenges, the healthcare system of Japan effectively managed rectal cancer surgeries during and after the pandemic. Robotic surgery became more widely adopted, and complication rates improved, demonstrating resilience and adaptability in surgical care.

INTRODUCTION:Multidisciplinary treatments for advanced rectal cancer are diverse. Neoadjuvant chemoradiation therapy (nCRT) is a total neoadjuvant therapy treatment option. Some studies have reported that tumor-infiltrating lymphocytes (TILs) and inflammatory blood factors (neutrophil-lymphocyte ratio [NLR], platelet-lymphocyte ratio [PLR], and systemic immune inflammatory index [SII]) are predictors of nCRT efficacy. However, the relationship between changes in TILs and inflammatory blood factors during nCRT and the resulting tumor regression grade (TRG) remains unclear. In this study, we investigated whether changes in TILs and inflammatory blood factors during nCRT were related to TRG. METHODS:We retrospectively studied 196 patients with rectal cancer who underwent curative resection after nCRT for advanced rectal cancer. Immunohistochemical staining of lymphocyte surface markers, including CD3, CD4, and CD8, was performed on biopsy specimens before and during nCRT. Inflammatory blood factors were assessed using blood samples collected before treatment and 7 days after the initiation of nCRT. RESULTS:Changes in CD4 levels were related to TRG. NLR, and SII during nCRT were associated with TRG. TRG tended to be better in patients with values below the cutoff. The NLR during nCRT and changes in NLR, PLR, and SII were associated with the tumor shrinkage rate. Changes in PLR were related to TRG. There was no relationship between TIL, peripheral blood changes, and recurrence rate. CONCLUSION:It was suggested that changes in CD4+ TILs immediately after treatment initiation and changes in inflammatory blood factors during treatment may be useful for predicting the reduction rate and TRG. These changes begin early during treatment and may be useful in predicting efficacy.

Robotic surgery has rapidly evolved, with telesurgery emerging as a promising extension. However, the lack of haptic feedback remains a key limitation, potentially compromising surgical safety. This study aimed to evaluate the impact of haptic feedback on surgical performance in both local and remote robotic settings using a cadaver model. Six gastrointestinal surgeons were assigned to local or remote groups and performed standardized bowel traction tasks using the Saroa™ surgical robot. Haptic feedback was tested at three levels: none (0), moderate (0.5), and full (1.0). Each participant completed the task three times under each condition. Task completion time, grip force, and forceps path length were measured. Grip force significantly decreased with increasing haptic feedback levels, particularly in the non-dominant (left) hand. No significant differences in task completion time or forceps path length were found across feedback levels or between local and remote settings, except for a longer right-hand path length in the remote group at feedback level 0.5. Haptic feedback reduced grip force in both local and remote robotic surgery, suggesting enhanced surgical safety. However, its effect on efficiency metrics was limited. These findings support the integration of haptic feedback in telesurgical systems, although further validation with complex procedures and more participants is warranted.

INTRODUCTION:Sclerosing hepatic hemangiomas are a rare form of cavernous hemangioma, reported in 0.2% of autopsy cases. Preoperative diagnosis is difficult because of the variety of imaging findings. Herein, we report a case of hepatic sclerosing hemangioma that was difficult to differentiate from a liver metastasis of rectal cancer. CASE PRESENTATION:A 67-year-old man visited our hospital with a chief complaint of bleeding during defecation, and a colonoscopy revealed advanced rectal cancer. A dynamic contrast-enhanced magnetic resonance imaging (MRI) showed a 15 mm-sized tumor in S7 of the liver. In the arterial phase, the tumor interior showed low signal intensity, and the tumor margins were enhanced. The tumor interior was gradually stained from portal to equilibrium phases. Partial S7 resection was performed for liver metastasis from rectal cancer. Hematoxylin and Eosin staining revealed flattened endothelial cells with poor atypia that formed a lumen. Immunohistochemical staining was positive for CD31 and CD34, and the final diagnosis was sclerosing hemangioma. CONCLUSION:Although a rare tumor, hepatic sclerosing hemangioma should always be considered as a differential diagnosis for liver tumors. If the diagnosis is difficult to make and malignancy cannot be ruled out, resection may be indicated as a diagnostic treatment.

ABSTRACT Aim Previous studies have shown that the volume and short‐term outcomes of advanced hepatectomy in Japan remained stable during the coronavirus disease 2019 (COVID‐19) pandemic. However, whether these trends have changed in the postpandemic period remains unclear. This study aimed to evaluate surgical volume and short‐term outcomes following advanced hepatectomy in Japan during the postpandemic era. Methods Data from the Japanese National Clinical Database (NCD) were analyzed for patients who underwent advanced hepatectomy between 2018 and 2023. Changes in the number of the procedures, major complications (Clavien–Dindo grade ≥ III), 30‐day and inhospital mortality rates, and failure‐to‐rescue rates were assessed. The standardized morbidity and mortality ratios—calculated as the observed‐to‐expected incidence rates using an NCD‐established risk model for 30‐day mortality, inhospital mortality, and major complications—were also examined. Results A total of 39 348 cases were included. The number of advanced hepatectomies showed a gradual decline, independent of the COVID‐19 pandemic. However, the proportion of patients aged over 80 years significantly increased throughout the study period. Monthly standardized mortality and morbidity ratios largely remained stable across the study period, including during the pandemic and postpandemic eras. Conclusions Analysis of data from a nationwide Japanese database indicates that advanced hepatectomy continues to be performed safely in the post‐COVID‐19 era, despite a decreasing procedural volume.

PURPOSE:This study aimed to investigate the effects of the coronavirus disease 2019 pandemic on morbidity and mortality after advanced hepatectomy by surgical volume in Japan. METHODS:Data from patients who underwent advanced hepatectomy between 2018 and 2022 from the Japanese National Clinical Database were collected. The transition of the number of hepatectomies and changes in risk-adjusted mortality and major complication rates based on the type of institutions certified by the Japan Society of Hepato-Biliary-Pancreatic Surgery were investigated. RESULTS:A total of 33 454 cases were included. The number of advanced hepatectomies gradually decreased, whereas the proportion of hepatectomies performed in certified institutions increased (from 63.4% in 2018 to 71.3% in 2022). Although the major complication rate in institution A was higher than that in institution B or noncertified institutions (16.3% vs. 14.5% vs. 13.5%), the in-hospital mortality rate was consistently favorable in the order of institution A, institution B, and noncertified institutions (1.4% vs. 2.0% vs. 2.8%). The monthly standardized mortality and major complication ratios did not significantly increase mostly throughout the pandemic, regardless of the institution type. CONCLUSIONS:The centralization to certified institutions progressed even during the pandemic. Surgical safety after advanced hepatectomy was satisfactorily maintained in any institution.

An increasing number of patients are undergoing conversion surgery owing to the rising popularity of relatively strong regimens such as immune checkpoint inhibitor (ICI)-combined chemotherapy for the treatment of unresectable esophageal or esophagogastric junction (EGJ) cancer. However, the perioperative safety of conversion surgery after ICI combined with chemotherapy remains unclear. We report two cases of postoperative immune-related adverse events (irAEs) in patients who underwent conversion surgery after the induction of ICI-combined chemotherapy. Case 1: A patient with unresectable EGJ adenocarcinoma and para-abdominal aortic lymph node (LN) metastasis developed adrenal insufficiency after four courses of nivolumab + S1 + oxaliplatin (Nivo+ SOX) therapy. As significant tumor shrinkage was observed, conversion surgery was performed. While the postoperative course was uneventful, two months after surgery, hypothyroidism developed and was determined to be an irAE. Thyroid hormone replacement therapy was administered and the symptoms improved. Case 2: A patient with EGJ adenocarcinoma and extensive metastasis to mediastinal, supraclavicular, and para-aortic LNs, along with aortic invasion, also received four courses of Nivo + SOX. Hypothyroidism developed during treatment and was managed with thyroid hormone replacement therapy. Following notable tumor regression, the patient underwent conversion surgery. The patient’s postoperative course was uneventful and was discharged. However, one month after surgery, the patient was readmitted with severe respiratory distress and was diagnosed with interstitial pneumonia. Intensive care with extracorporeal membrane oxygenation (ECMO) was initiated following steroid and endoxan pulse therapy, but the patient died four months after surgery. The risk of irAEs should always be considered in patients receiving ICIs, even after conversion surgery. This condition should be differentiated from complications of esophagectomy and managed promptly.

To evaluate the feasibility of secure telesurgery by assessing the impact of image compression and cybersecurity devices on surgical performance and data transmission. Telesurgical procedures using the hinotori™ surgical robot were performed remotely between Hirosaki and Goshogawara, which are 30 km apart, over a secure line provided by NTT East. Image compression was tested at 120, 80, 60, 40, and 20 Mbps. A surgical specialist operated on artificial organ models. Simulated cyberattacks were introduced to assess the performance of security devices. Even at 20 Mbps, there was no significant loss in operability or image quality. Security devices detected simulated attacks and permitted essential robot communications. No visual distortion or operational issues occurred, and only a small delay of ≤ 2 min was introduced. The transmission control protocol (TCP) error rates remained low, with or without security devices (0.00–0.04

The recurrence rates in patients with esophageal cancer who are treated by curative esophagectomy is very poor. On the other hand, some patients with recurrence after esophagectomy have achieved long-term survival with multidisciplinary treatment. Recently, the concept of oligo-recurrence has gained attention. We investigated the characteristics and prognosis of patients with oligo-recurrence after esophagectomy. We included 135 patients with recurrence among 490 patients who underwent esophagectomy for esophageal cancer between January 2010 and March 2021 at our hospital. Oligo-recurrence was defined as five or fewer recurrences in a single organ or five or fewer recurrences in a single lymph node. Patients were divided into two groups: the oligo-recurrence group and the non oligo-recurrence group. We evaluated the prognosis of patients with oligo-recurrence, focusing especially on its correlation with the site of recurrence, treatment after recurrence. Of the 135 recurrence patients, 46 (34%) were in the oligo-recurrence group and 89 (66%) were in the non oligo-recurrence group. The overall survival was 38 months in the oligo-recurrence group and 18 months in the non oligo-recurrence group (p < 0.001). Survival after recurrence was 23 months in the oligo-recurrence group and 7 months in the non oligo-recurrence group (p < 0.001). The prognosis was better in the lymph node recurrence group than in the liver recurrence group (p = 0.04). 25 lymph node recurrence patients (86%) received chemoradiotherapy, all liver recurrence patients received chemotherapy, and 4 lung recurrence patients (80%) patients underwent lung resection. Oligo-recurrence after radical esophagectomy for esophageal cancer may be associated with a favorable prognosis. Radical treatment may be useful in lymph node and lung oligo-recurrence.