Congratulations to the authors on their insightful and thorough study exploring Siewert II and III early gastric cancer (EGC) and the application of endoscopic submucosal dissection [1]. This work significantly contributes to our understanding of the factors influencing lymph node metastasis in these specific cancer subtypes.

One of the key strengths of the study is its emphasis on the critical role of lymphovascular invasion as a predictor of lymph node metastasis. By highlighting this association, the authors reinforce the importance of thorough histopathological examination in determining the metastatic potential of EGC. This finding is in line with existing literature, emphasizing that lymphovascular invasion is a crucial parameter in the assessment and management of gastric cancer.

Moreover, the study presents an intriguing finding regarding the macroscopic morphology of the cancer. The authors report that an elevated macroscopic morphology is associated with an increased risk of lymph node metastasis. This result is particularly noteworthy as it contrasts with the findings of several other studies that have not established such a correlation. This divergence underscores the need for further research and may serve as a critical alert to endoscopists that relying solely on the macroscopic appearance of the lesion to determine its resectability may be inadequate and potentially misleading.

In addition to these significant contributions, I have a specific question for the authors regarding the case of lymph node metastasis with SM1 invasion: did this particular patient exhibit lymphovascular invasion? Clarification on this point would enhance our understanding of the study’s findings and their alignment with established treatment protocols.

Overall, this study provides valuable insights and raises important considerations for the management of Siewert II and III EGC. The findings contribute to the growing body of evidence that informs clinical practice and may ultimately improve patient outcomes by guiding more precise and individualized treatment strategies. I commend the authors for their contribution to the field and look forward to future studies that build upon these important findings.

Thank you for your kind comment. Lymphovascular invasion was detected in the patient who had lymph node metastasis with SM1 invasion. Therefore, it was in line with Korean and Japanese gastric cancer treatment guidelines. Thank you again for reviewing our research.