Research progress of adenocarcinoma of esophago-gastric junction_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Yong ¹ , LI Weiping ² , LIAO Zongyuan ¹ , XIONG Hui ¹ ,  ZHANG Jiangnan ¹

1. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, P.R.China;
2. Department of Gastrointestinal Surgery, The First People’s Hospital of Taicang, Taicang, Jiangsu 215400, P.R.China;

Corresponding author：

ZHANG Jiangnan, Email: zjnss@sina.com

Keywords：

adenocarcinoma of esophago-gastric junction; Siewert classification; lymph node metastasis; surgical procedure; chemotherapy

DOI：

10.7507/1007-9424.201609058

Video：

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Objective To summarize the research progress of the adenocarcinoma of esophago-gastric junction (AEG) in recent years, in order to improve the further understanding of this disease. Method The literatures about application and research progress of AEG were researched and reviewed. Results Siewert classification was a widely recognized classification for AEG, according to this classification, AEG was divided into typeⅠ, Ⅱ, and Ⅲ. Gastroesophageal reflux, Barrett’ sesophagus, and the infection of Helicobacter pylori may be the important pathogenic factors. For SiewertⅠAEG, thoracic approach was preferred commonly, and for SiewertⅡand Ⅲ AEG, total gastrectomy through abdominal approach and distal partial resection of esophagus through diaphragmatic hiatus approach were recommended. Endoscopic submucosal resection, neoadjuvant therapy, targeted therapy, and multidisciplinary team were becoming more and more important in the treatment of AEG. Conclusions The choice of surgical method and resection range should according to the types of AEG. Comprehensive assessment and comprehensive treatment would be performed, so that effect of treatment may be improved.

Citation： YANG Yong, LI Weiping, LIAO Zongyuan, XIONG Hui, ZHANG Jiangnan. Research progress of adenocarcinoma of esophago-gastric junction. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(6): 765-769. doi: 10.7507/1007-9424.201609058 Copy

1.	Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3^rd English edition. Gastric Cancer, 2011, 14(2): 101-112.
2.	Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg, 1998, 85(11): 1457-1459.
3.	胡祥. 日本《胃癌治疗指南》(第 3 版)解读. 中国实用外科杂志, 2010, 30(1): 25-30.
4.	Wu A, Ji J. Adenocarcinoma of esophagogastric junction requires a clearer definition. Transl Gastrointest Cancer, 2013, 2 Supplement 1: 5-9.
5.	胡祥. 2014 年第 4 版日本《胃癌治疗指南》更新要旨. 中国实用外科杂志, 2015, 35(1): 16-19.
6.	Dolan K, Morris AI, Gosney JR, et al. Three different subsite classification systems for carcinomas in the proximity of the GEJ, but is it all one disease? J Gastroenterol Hepatol, 2004, 19(1): 24-30.
7.	封巍, 郑晓. 食管胃交界部肿瘤的综合治疗. 2013 华东胸部肿瘤论坛暨浙江省胸部肿瘤论坛, 浙江省, 2013: 34-44.
8.	Orditura M, Galizia G, Lieto E, et al. Treatment of esophagogastric junction carcinoma: an unsolved debate. World J Gastroenterol, 2015, 21(15): 4427-4431.
9.	Liu K, Yang K, Zhang W, et al. Changes of esophagogastric junctional adenocarcinoma and gastroesophageal reflux disease among surgical patients during 1988-2012: a single-institution, high-volume experience in China. Ann Surg, 2016, 263(1): 88-95.
10.	Buas MF, Vaughan TL. Epidemiology and risk factors for gastroesophageal junction tumors: understanding the rising incidence of this disease. Semin Radiat Oncol, 2013, 23(1): 3-9.
11.	中华医学会消化病学分会. Barrett 食管诊治共识(2011 修订版, 重庆). 中华消化内镜杂志, 2011, 28(8): 421-422.
12.	Runge TM, Abrams JA, Shaheen NJ. Epidemiology of Barrett’s esophagus and esophageal adenocarcinoma. Gastroenterol Clin North Am, 2015, 44(2): 203-231.
13.	Strong VE, Wu AW, Selby LV, et al. Differences in gastric cancer survival between the U. S. and China. J Surg Oncol, 2015, 112(1): 31-37.
14.	Rubenstein JH, Inadomi JM, Scheiman J, et al. Association between Helicobacter pylori and Barrett’s esophagus, erosive esophagitis, and gastroesophageal reflux symptoms. Clin Gastroenterol Hepatol, 2014, 12(2): 239-245.
15.	闵国清, 谢丹, 孔德钊. 巴雷特食管临床分析. 中华消化病与影像杂志(电子版), 2014, 4(1): 31-33.
16.	汪萍波. Hp 感染与胃癌相关性的临床研究. 浙江临床医学, 2010, 12(10): 1105-1106.
17.	常廷民, 李建生, 李秀敏. 贲门癌与幽门螺杆菌感染的相关性研究. 中华医院感染学杂志, 2013, 23(6): 1464-1466.
18.	Mitchell D, Derakhshan M, Wirz A, et al. PWE-071 the majority of H. Pylori infected subjects have reduced intragastric acidity and parietal cell density which is most marked close to the gastroesophageal junction. Gut, 2016, 65(Suppl 1): A172-A173.
19.	Feith M, Stein HJ, Siewert JR. Adenocarcinoma of the esophagogastric junction: surgical therapy based on 1 602 consecutive resected patients. Surg Oncol Clin N Am, 2006, 15(4): 751-764.
20.	陈凛, 张士武. 食管胃结合部腺癌淋巴结转移规律及其对临床指导意义. 中国实用外科杂志, 2012, 32(4): 277-280.
21.	季加孚, 季鑫. 食管胃结合部腺癌的外科治疗. 中华消化外科杂志, 2014, 13(2): 81-84.
22.	Hulscher JB, van Sandick JW, de Boer AG, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med, 2002, 347(21): 1662-1669.
23.	Khullar OV, Jiang R, Force SD, et al. Transthoracic versus transhiatal resection for esophageal adenocarcinoma of the lower esophagus: a value-based comparison. J Surg Oncol, 2015, 112(5): 517-523.
24.	Kurokawa Y, Sasako M, Sano T, et al. Ten-year follow-up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia. Br J Surg, 2015, 102(4): 341-348.
25.	马小明, 吴建强, 王建. 食管胃结合部腺癌的研究进展. 中国普外基础与临床杂志, 2015, 22(5): 637-641.
26.	Zheng Z, Cai J, Yin J, et al. Transthoracic versus abdominal-transhiatal resection for treating Siewert typeⅡ/Ⅲadenocarcinoma of the esophagogastric junction: a meta-analysis. Int J Clin Exp Med, 2015, 8(10): 17167-17182.
27.	黄雷, 徐阿曼, 韩文秀, 等. SiewertⅡ 型和 Ⅲ 型食管胃结合部腺癌全胃与近端胃切除术的疗效比较. 中华消化外科杂志, 2014, 13(2): 110-114.
28.	Takeuchi H, Kitagawa Y. Adenocarcinoma of the esophagogastric junction: territory of the esophagus or stomach, or an independent region? Ann Surg Oncol, 2013, 20(3): 705-706.
29.	Masuzawa T, Takiguchi S, Hirao M, et al. Comparison of perioperative and long-term outcomes of total and proximal gastrectomy for early gastric cancer: a multi-institutional retrospective study. World J Surg, 2014, 38(5): 1100-1106.
30.	Nozaki I, Hato S, Kobatake T, et al. Long-term outcome after proximal gastrectomy with jejunal interposition for gastric cancer compared with total gastrectomy. World J Surg, 2013, 37(3): 558-564.
31.	赵群, 姚继方, 李勇, 等. SiewertⅡ、Ⅲ 型食管胃结合部腺癌两种外科手术入路治疗效果的研究. 腹部外科, 2013, 26(4): 238-240.
32.	Takiguchi N, Takahashi M, Ikeda M, et al. Long-term quality-of-life comparison of total gastrectomy and proximal gastrectomy by postgastrectomy syndrome assessment scale (PGSAS-45): a nationwide multi-institutional study. Gastric Cancer, 2015, 18(2): 407-416.
33.	郑国良, 郑志超, 赵岩, 等. 根治性胃切除术治疗 SiewertⅡ 和 Ⅲ 型食管胃结合部腺癌的疗效分析. 中华肿瘤杂志, 2016, 38(7): 538-542.
34.	白顺滟, 肖思洁, 吴俊超, 等. 内镜黏膜下剥离术和黏膜切除术治疗早期胃癌的临床对比分析. 中国内镜杂志, 2014, 20(8): 873-877.
35.	Namasivayam V, Wang KK, Prasad GA. Endoscopic mucosal resection in the management of esophageal neoplasia: current status and future directions. Clin Gastroenterol Hepatol, 2010, 8(9): 743-754.
36.	Ronellenfitsch U, Schwarzbach M, Hofheinz R, et al. Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus. Cochrane Database Syst Rev, 2013, 5(5): 1-88.
37.	Kumagai K, Rouvelas I, Tsai JA, et al. Survival benefit and additional value of preoperative chemoradiotherapy in resectable gastric and gastro-oesophageal junction cancer: a direct and adjusted indirect comparison meta-analysis. Eur J Surg Oncol, 2015, 41(3): 282-294.
38.	Shapiro J, van Lanschot JJ, Hulshof MC, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol, 2015, 16(9): 1090-1098.
39.	Narita T, Seshimo A, Suzuki M, et al. Status of tissue expression and serum levels of HER2 in gastric cancer patients in Japan. Hepatogastroenterology, 2013, 60(125): 1083-1088.
40.	王士娜, 马静, 杨立宇, 等. HER2/neu 和 Akt2 在胃癌中的表达及意义. 中国医科大学学报, 2013, 42(2): 131-134.
41.	Soularue É, Cohen R, Tournigand C, et al. Efficacy and safety of trastuzumab in combination with oxaliplatin and fluorouracil-based chemotherapy for patients with HER2-positive metastatic gastric and gastro-oesophageal junction adenocarcinoma patients: a retrospective study. Bull Cancer, 2015, 102(4): 324-331.
42.	徐泽宽. 2015 年 V1 版《NCCN 胃癌临床实践指南》更新解读. 中国实用外科杂志, 2015, (5): 512-514.
43.	Okines A, Verheij M, Allum W, et al. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2010, 21 Suppl 5: v50-v54.

1. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3^rd English edition. Gastric Cancer, 2011, 14(2): 101-112.
2. Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg, 1998, 85(11): 1457-1459.
3. 胡祥. 日本《胃癌治疗指南》(第 3 版)解读. 中国实用外科杂志, 2010, 30(1): 25-30.
4. Wu A, Ji J. Adenocarcinoma of esophagogastric junction requires a clearer definition. Transl Gastrointest Cancer, 2013, 2 Supplement 1: 5-9.
5. 胡祥. 2014 年第 4 版日本《胃癌治疗指南》更新要旨. 中国实用外科杂志, 2015, 35(1): 16-19.
6. Dolan K, Morris AI, Gosney JR, et al. Three different subsite classification systems for carcinomas in the proximity of the GEJ, but is it all one disease? J Gastroenterol Hepatol, 2004, 19(1): 24-30.
7. 封巍, 郑晓. 食管胃交界部肿瘤的综合治疗. 2013 华东胸部肿瘤论坛暨浙江省胸部肿瘤论坛, 浙江省, 2013: 34-44.
8. Orditura M, Galizia G, Lieto E, et al. Treatment of esophagogastric junction carcinoma: an unsolved debate. World J Gastroenterol, 2015, 21(15): 4427-4431.
9. Liu K, Yang K, Zhang W, et al. Changes of esophagogastric junctional adenocarcinoma and gastroesophageal reflux disease among surgical patients during 1988-2012: a single-institution, high-volume experience in China. Ann Surg, 2016, 263(1): 88-95.
10. Buas MF, Vaughan TL. Epidemiology and risk factors for gastroesophageal junction tumors: understanding the rising incidence of this disease. Semin Radiat Oncol, 2013, 23(1): 3-9.
11. 中华医学会消化病学分会. Barrett 食管诊治共识(2011 修订版, 重庆). 中华消化内镜杂志, 2011, 28(8): 421-422.
12. Runge TM, Abrams JA, Shaheen NJ. Epidemiology of Barrett’s esophagus and esophageal adenocarcinoma. Gastroenterol Clin North Am, 2015, 44(2): 203-231.
13. Strong VE, Wu AW, Selby LV, et al. Differences in gastric cancer survival between the U. S. and China. J Surg Oncol, 2015, 112(1): 31-37.
14. Rubenstein JH, Inadomi JM, Scheiman J, et al. Association between Helicobacter pylori and Barrett’s esophagus, erosive esophagitis, and gastroesophageal reflux symptoms. Clin Gastroenterol Hepatol, 2014, 12(2): 239-245.
15. 闵国清, 谢丹, 孔德钊. 巴雷特食管临床分析. 中华消化病与影像杂志(电子版), 2014, 4(1): 31-33.
16. 汪萍波. Hp 感染与胃癌相关性的临床研究. 浙江临床医学, 2010, 12(10): 1105-1106.
17. 常廷民, 李建生, 李秀敏. 贲门癌与幽门螺杆菌感染的相关性研究. 中华医院感染学杂志, 2013, 23(6): 1464-1466.
18. Mitchell D, Derakhshan M, Wirz A, et al. PWE-071 the majority of H. Pylori infected subjects have reduced intragastric acidity and parietal cell density which is most marked close to the gastroesophageal junction. Gut, 2016, 65(Suppl 1): A172-A173.
19. Feith M, Stein HJ, Siewert JR. Adenocarcinoma of the esophagogastric junction: surgical therapy based on 1 602 consecutive resected patients. Surg Oncol Clin N Am, 2006, 15(4): 751-764.
20. 陈凛, 张士武. 食管胃结合部腺癌淋巴结转移规律及其对临床指导意义. 中国实用外科杂志, 2012, 32(4): 277-280.
21. 季加孚, 季鑫. 食管胃结合部腺癌的外科治疗. 中华消化外科杂志, 2014, 13(2): 81-84.
22. Hulscher JB, van Sandick JW, de Boer AG, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med, 2002, 347(21): 1662-1669.
23. Khullar OV, Jiang R, Force SD, et al. Transthoracic versus transhiatal resection for esophageal adenocarcinoma of the lower esophagus: a value-based comparison. J Surg Oncol, 2015, 112(5): 517-523.
24. Kurokawa Y, Sasako M, Sano T, et al. Ten-year follow-up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia. Br J Surg, 2015, 102(4): 341-348.
25. 马小明, 吴建强, 王建. 食管胃结合部腺癌的研究进展. 中国普外基础与临床杂志, 2015, 22(5): 637-641.
26. Zheng Z, Cai J, Yin J, et al. Transthoracic versus abdominal-transhiatal resection for treating Siewert typeⅡ/Ⅲadenocarcinoma of the esophagogastric junction: a meta-analysis. Int J Clin Exp Med, 2015, 8(10): 17167-17182.
27. 黄雷, 徐阿曼, 韩文秀, 等. SiewertⅡ 型和 Ⅲ 型食管胃结合部腺癌全胃与近端胃切除术的疗效比较. 中华消化外科杂志, 2014, 13(2): 110-114.
28. Takeuchi H, Kitagawa Y. Adenocarcinoma of the esophagogastric junction: territory of the esophagus or stomach, or an independent region? Ann Surg Oncol, 2013, 20(3): 705-706.
29. Masuzawa T, Takiguchi S, Hirao M, et al. Comparison of perioperative and long-term outcomes of total and proximal gastrectomy for early gastric cancer: a multi-institutional retrospective study. World J Surg, 2014, 38(5): 1100-1106.
30. Nozaki I, Hato S, Kobatake T, et al. Long-term outcome after proximal gastrectomy with jejunal interposition for gastric cancer compared with total gastrectomy. World J Surg, 2013, 37(3): 558-564.
31. 赵群, 姚继方, 李勇, 等. SiewertⅡ、Ⅲ 型食管胃结合部腺癌两种外科手术入路治疗效果的研究. 腹部外科, 2013, 26(4): 238-240.
32. Takiguchi N, Takahashi M, Ikeda M, et al. Long-term quality-of-life comparison of total gastrectomy and proximal gastrectomy by postgastrectomy syndrome assessment scale (PGSAS-45): a nationwide multi-institutional study. Gastric Cancer, 2015, 18(2): 407-416.
33. 郑国良, 郑志超, 赵岩, 等. 根治性胃切除术治疗 SiewertⅡ 和 Ⅲ 型食管胃结合部腺癌的疗效分析. 中华肿瘤杂志, 2016, 38(7): 538-542.
34. 白顺滟, 肖思洁, 吴俊超, 等. 内镜黏膜下剥离术和黏膜切除术治疗早期胃癌的临床对比分析. 中国内镜杂志, 2014, 20(8): 873-877.
35. Namasivayam V, Wang KK, Prasad GA. Endoscopic mucosal resection in the management of esophageal neoplasia: current status and future directions. Clin Gastroenterol Hepatol, 2010, 8(9): 743-754.
36. Ronellenfitsch U, Schwarzbach M, Hofheinz R, et al. Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus. Cochrane Database Syst Rev, 2013, 5(5): 1-88.
37. Kumagai K, Rouvelas I, Tsai JA, et al. Survival benefit and additional value of preoperative chemoradiotherapy in resectable gastric and gastro-oesophageal junction cancer: a direct and adjusted indirect comparison meta-analysis. Eur J Surg Oncol, 2015, 41(3): 282-294.
38. Shapiro J, van Lanschot JJ, Hulshof MC, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol, 2015, 16(9): 1090-1098.
39. Narita T, Seshimo A, Suzuki M, et al. Status of tissue expression and serum levels of HER2 in gastric cancer patients in Japan. Hepatogastroenterology, 2013, 60(125): 1083-1088.
40. 王士娜, 马静, 杨立宇, 等. HER2/neu 和 Akt2 在胃癌中的表达及意义. 中国医科大学学报, 2013, 42(2): 131-134.
41. Soularue É, Cohen R, Tournigand C, et al. Efficacy and safety of trastuzumab in combination with oxaliplatin and fluorouracil-based chemotherapy for patients with HER2-positive metastatic gastric and gastro-oesophageal junction adenocarcinoma patients: a retrospective study. Bull Cancer, 2015, 102(4): 324-331.
42. 徐泽宽. 2015 年 V1 版《NCCN 胃癌临床实践指南》更新解读. 中国实用外科杂志, 2015, (5): 512-514.
43. Okines A, Verheij M, Allum W, et al. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2010, 21 Suppl 5: v50-v54.

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