Controversy, consensus, and progress in surgical treatment of esophagogastric junction adenocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 HU Jiankun , CHEN Xiaolong

Gastric Cancer Center, Laboratory of Gastric Cancer, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

HU Jiankun, Email: hujkwch@126.com

Keywords：

esophagogastric junction adenocarcinoma; surgery treatment; resection; lymphadenectomy; digestive tract reconstruction; neoadjuvant therapy

DOI：

10.7507/1007-9424.202309026

Video：

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The incidence of esophagogastric junction adenocarcinoma is gradually increasing, and gastrointestinal surgery and thoracic surgery are paying more and more attention to its surgical treatment. “Chinese expert consensus on the surgical treatment of adenocarcinoma of esophagogastric junction (2018 edition)” discussed the core issues in the field of surgical treatment such as definition, classification, surgical approach, lymphadenectomy, digestive tract reconstruction, and neoadjuvant therapy for esophagogastric junction adenocarcinoma, and gave recommendations. However, there is still some controversy about these issues. The author discussed the consensus and controversial issues relevant to esophagogastric junction adenocarcinoma and related research progress in recent years.

Citation： HU Jiankun, CHEN Xiaolong. Controversy, consensus, and progress in surgical treatment of esophagogastric junction adenocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(10): 1153-1158. doi: 10.7507/1007-9424.202309026 Copy

1.	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.
2.	国际食管疾病学会中国分会(CSDE)食管胃结合部疾病跨界联盟, 中国医师协会内镜医师分会腹腔镜外科专业委员会, 中国医师协会外科医师分会上消化道外科医师专业委员会, 等. 食管胃结合部腺癌外科治疗中国专家共识(2018年版). 中华胃肠外科杂志, 2018, 21(9): 961-975.
3.	Nagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology, 2020, 76(2): 182-188.
4.	Nishi M, Noumura H, Kajisa T, et al. Surgical problem of carcinoma in the esophagogastric junction (In Japanese with English abstract). Stomach Intest, 1978, 13: 1497-1507.
5.	Siewert JR, Stein HJ. Adenocarcinoma of the gastroesophageal junction: classification, pathology and extent of resection. Dis Esoph, 1996, 9: 173-182.
6.	邱江锋, 马欣俐. 食管胃结合部癌分型的思考与争议: 基于食管浸润长度的改良分型. 中华消化外科杂志, 2022, 21(8): 1050-1055.
7.	Liu K, Feng F, Chen XZ, et al. Comparison between gastric and esophageal classification system among adenocarcinomas of esophagogastric junction according to AJCC 8th edition: a retrospective observational study from two high-volume institutions in China. Gastric Cancer, 2019, 22(3): 506-517.
8.	Ajani JA, D’Amico TA, Bentrem DJ, et al. Gastric cancer, version 2. 2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2022, 20(2): 167-192.
9.	Ajani JA, D’Amico TA, Bentrem DJ, et al. Esophageal and esophagogastric junction cancers, version 2. 2023, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2023, 21(4): 393-422.
10.	中华医学会外科学分会腹腔镜与内镜外科学组. Siewert Ⅱ型食管胃结合部腺癌腔镜手术治疗中国专家共识(2019版). 中国实用外科杂志, 2019, 39(11): 1129-1135.
11.	Siewert JR, Stein HJ, Feith M. Adenocarcinoma of the esophago-gastric junction. Scand J Surg, 2006, 95(4): 260-269.
12.	Zhang W, Chen X, Liu K, et al. Comparison of survival outcomes between transthoracic and transabdominal surgical approaches in patients with Siewert-Ⅱ/Ⅲ esophagogastric junction adenocarcinoma: a single-institution retrospective cohort study. Chin J Cancer Res, 2016, 28(4): 413-422.
13.	Rüdiger Siewert J, Feith M, Werner M, et al. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1 002 consecutive patients. Ann Surg, 2000, 232(3): 353-361.
14.	Matsuda T, Kurokawa Y, Yoshikawa T, et al. Clinicopathological characteristics and prognostic factors of patients with Siewert type Ⅱ esophagogastric junction carcinoma: a retrospective multicenter study. World J Surg, 2016, 40(7): 1672-1679.
15.	马海霞, 张勇, 张卫国, 等. Siewert Ⅱ型食管胃结合部腺癌侵犯食管胃结合部黏膜下不同静脉分区对下纵隔和食管裂孔淋巴结转移的影响. 中华消化外科杂志, 2023, 22(3): 391-398.
16.	张克昌, 范林广, 王杰, 等. SiewertⅡ型和Ⅲ型食管胃结合部腺癌下纵隔淋巴结转移影响因素及转移规律分析. 中华消化外科杂志, 2022, 21(10): 1370-1375.
17.	胡旭, 郑佳彬, 许庆文, 等. 手术入路对食管胃结合部腺癌生存预后的影响. 腹腔镜外科杂志, 2021, 26(1): 26-31.
18.	Yang ZF, Wu DQ, Wang JJ, et al. Surgical approach for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction: transthoracic or transabdominal? —A single-center retrospective study. Ann Transl Med, 2018, 6(23): 450.
19.	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.
20.	Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2021 (6th edition). Gastric Cancer, 2023, 26(1): 1-25.
21.	Kurokawa Y, Takeuchi H, Doki Y, et al. Mapping of lymph node metastasis from esophagogastric junction tumors: a prospective nationwide multicenter study. Ann Surg, 2021, 274(1): 120-127.
22.	中华人民共和国国家卫生健康委员会医政医管局. 胃癌诊疗指南(2022年版). 中华消化外科杂志, 2022, 21(9): 1137-1164.
23.	Fujitani K, Miyashiro I, Mikata S, et al. Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type Ⅱ adenocarcinoma of the cardia: results of a multicenter study. Gastric Cancer, 2013, 16(3): 301-308.
24.	Yamashita H, Seto Y, Sano T, et al. Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma. Gastric Cancer, 2017, 20(Suppl 1): 69-83.
25.	尤俊, 牛兆建, 樊林, 等. 腹腔镜近端胃切除术治疗近端胃癌和食管胃结合部腺癌安全性和近期疗效的多中心研究. 中华消化外科杂志, 2023, 22(3): 355-362.
26.	邹庆涛, 张洪贞, 尹作文, 等. 食管胃结合部腺癌根治术三种消化道重建方式的临床效果评价. 中华普外科手术学杂志(电子版), 2022, 16(5): 545-548.
27.	戴文鹏, 邱卫明, 王克强, 等. 食管胃结合部癌完全腹腔镜全胃切除术不同消化道重建方案对比研究. 中华普外科手术学杂志(电子版), 2023, 17(3): 300-304.
28.	Bissolati M, Desio M, Rosa F, et al. Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer: an Italian multicenter study. Gastric Cancer, 2017, 20(1): 70-82.
29.	Barbour AP, Rizk NP, Gonen M, et al. Adenocarcinoma of the gastroesophageal junction: influence of esophageal resection margin and operative approach on outcome. Ann Surg, 2007, 246(1): 1-8.
30.	Mine S, Sano T, Hiki N, et al. Proximal margin length with transhiatal gastrectomy for Siewert type Ⅱ and Ⅲ adenocarcinomas of the oesophagogastric junction. Br J Surg, 2013, 100(8): 1050-1054.
31.	田园, 王强, 王军, 等. 新辅助同步放化疗联合手术对比直接手术治疗Siewert Ⅱ、Ⅲ型食管胃结合部腺癌随机对照试验的远期预后分析. 中华胃肠外科杂志, 2021, 24(2): 128-137.
32.	林佳锐, 庄业忠, 王伟峰, 等. 新辅助化疗治疗可切除局部晚期食管胃结合部腺癌的疗效分析. 中华消化外科杂志, 2018, 17(6): 619-625.
33.	André T, Tougeron D, Piessen G, et al. Neoadjuvant nivolumab plus ipilimumab and adjuvant nivolumab in localized deficient mismatch repair/microsatellite instability-high gastric or esophagogastric junction adenocarcinoma: the GERCOR NEONIPIGA phase Ⅱ Study. J Clin Oncol, 2023, 41(2): 255-265.

1. 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.
2. 国际食管疾病学会中国分会(CSDE)食管胃结合部疾病跨界联盟, 中国医师协会内镜医师分会腹腔镜外科专业委员会, 中国医师协会外科医师分会上消化道外科医师专业委员会, 等. 食管胃结合部腺癌外科治疗中国专家共识(2018年版). 中华胃肠外科杂志, 2018, 21(9): 961-975.
3. Nagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology, 2020, 76(2): 182-188.
4. Nishi M, Noumura H, Kajisa T, et al. Surgical problem of carcinoma in the esophagogastric junction (In Japanese with English abstract). Stomach Intest, 1978, 13: 1497-1507.
5. Siewert JR, Stein HJ. Adenocarcinoma of the gastroesophageal junction: classification, pathology and extent of resection. Dis Esoph, 1996, 9: 173-182.
6. 邱江锋, 马欣俐. 食管胃结合部癌分型的思考与争议: 基于食管浸润长度的改良分型. 中华消化外科杂志, 2022, 21(8): 1050-1055.
7. Liu K, Feng F, Chen XZ, et al. Comparison between gastric and esophageal classification system among adenocarcinomas of esophagogastric junction according to AJCC 8th edition: a retrospective observational study from two high-volume institutions in China. Gastric Cancer, 2019, 22(3): 506-517.
8. Ajani JA, D’Amico TA, Bentrem DJ, et al. Gastric cancer, version 2. 2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2022, 20(2): 167-192.
9. Ajani JA, D’Amico TA, Bentrem DJ, et al. Esophageal and esophagogastric junction cancers, version 2. 2023, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2023, 21(4): 393-422.
10. 中华医学会外科学分会腹腔镜与内镜外科学组. Siewert Ⅱ型食管胃结合部腺癌腔镜手术治疗中国专家共识(2019版). 中国实用外科杂志, 2019, 39(11): 1129-1135.
11. Siewert JR, Stein HJ, Feith M. Adenocarcinoma of the esophago-gastric junction. Scand J Surg, 2006, 95(4): 260-269.
12. Zhang W, Chen X, Liu K, et al. Comparison of survival outcomes between transthoracic and transabdominal surgical approaches in patients with Siewert-Ⅱ/Ⅲ esophagogastric junction adenocarcinoma: a single-institution retrospective cohort study. Chin J Cancer Res, 2016, 28(4): 413-422.
13. Rüdiger Siewert J, Feith M, Werner M, et al. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1 002 consecutive patients. Ann Surg, 2000, 232(3): 353-361.
14. Matsuda T, Kurokawa Y, Yoshikawa T, et al. Clinicopathological characteristics and prognostic factors of patients with Siewert type Ⅱ esophagogastric junction carcinoma: a retrospective multicenter study. World J Surg, 2016, 40(7): 1672-1679.
15. 马海霞, 张勇, 张卫国, 等. Siewert Ⅱ型食管胃结合部腺癌侵犯食管胃结合部黏膜下不同静脉分区对下纵隔和食管裂孔淋巴结转移的影响. 中华消化外科杂志, 2023, 22(3): 391-398.
16. 张克昌, 范林广, 王杰, 等. SiewertⅡ型和Ⅲ型食管胃结合部腺癌下纵隔淋巴结转移影响因素及转移规律分析. 中华消化外科杂志, 2022, 21(10): 1370-1375.
17. 胡旭, 郑佳彬, 许庆文, 等. 手术入路对食管胃结合部腺癌生存预后的影响. 腹腔镜外科杂志, 2021, 26(1): 26-31.
18. Yang ZF, Wu DQ, Wang JJ, et al. Surgical approach for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction: transthoracic or transabdominal? —A single-center retrospective study. Ann Transl Med, 2018, 6(23): 450.
19. 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.
20. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2021 (6th edition). Gastric Cancer, 2023, 26(1): 1-25.
21. Kurokawa Y, Takeuchi H, Doki Y, et al. Mapping of lymph node metastasis from esophagogastric junction tumors: a prospective nationwide multicenter study. Ann Surg, 2021, 274(1): 120-127.
22. 中华人民共和国国家卫生健康委员会医政医管局. 胃癌诊疗指南(2022年版). 中华消化外科杂志, 2022, 21(9): 1137-1164.
23. Fujitani K, Miyashiro I, Mikata S, et al. Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type Ⅱ adenocarcinoma of the cardia: results of a multicenter study. Gastric Cancer, 2013, 16(3): 301-308.
24. Yamashita H, Seto Y, Sano T, et al. Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma. Gastric Cancer, 2017, 20(Suppl 1): 69-83.
25. 尤俊, 牛兆建, 樊林, 等. 腹腔镜近端胃切除术治疗近端胃癌和食管胃结合部腺癌安全性和近期疗效的多中心研究. 中华消化外科杂志, 2023, 22(3): 355-362.
26. 邹庆涛, 张洪贞, 尹作文, 等. 食管胃结合部腺癌根治术三种消化道重建方式的临床效果评价. 中华普外科手术学杂志(电子版), 2022, 16(5): 545-548.
27. 戴文鹏, 邱卫明, 王克强, 等. 食管胃结合部癌完全腹腔镜全胃切除术不同消化道重建方案对比研究. 中华普外科手术学杂志(电子版), 2023, 17(3): 300-304.
28. Bissolati M, Desio M, Rosa F, et al. Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer: an Italian multicenter study. Gastric Cancer, 2017, 20(1): 70-82.
29. Barbour AP, Rizk NP, Gonen M, et al. Adenocarcinoma of the gastroesophageal junction: influence of esophageal resection margin and operative approach on outcome. Ann Surg, 2007, 246(1): 1-8.
30. Mine S, Sano T, Hiki N, et al. Proximal margin length with transhiatal gastrectomy for Siewert type Ⅱ and Ⅲ adenocarcinomas of the oesophagogastric junction. Br J Surg, 2013, 100(8): 1050-1054.
31. 田园, 王强, 王军, 等. 新辅助同步放化疗联合手术对比直接手术治疗Siewert Ⅱ、Ⅲ型食管胃结合部腺癌随机对照试验的远期预后分析. 中华胃肠外科杂志, 2021, 24(2): 128-137.
32. 林佳锐, 庄业忠, 王伟峰, 等. 新辅助化疗治疗可切除局部晚期食管胃结合部腺癌的疗效分析. 中华消化外科杂志, 2018, 17(6): 619-625.
33. André T, Tougeron D, Piessen G, et al. Neoadjuvant nivolumab plus ipilimumab and adjuvant nivolumab in localized deficient mismatch repair/microsatellite instability-high gastric or esophagogastric junction adenocarcinoma: the GERCOR NEONIPIGA phase Ⅱ Study. J Clin Oncol, 2023, 41(2): 255-265.

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Controversy, consensus, and progress in surgical treatment of esophagogastric junction adenocarcinoma

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