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.	國際食管疾病學會中國分會(CSDE)食管胃結合部疾病跨界聯盟, 中國醫師協會內鏡醫師分會腹腔鏡外科專業委員會, 中國醫師協會外科醫師分會上消化道外科醫師專業委員會, 等. 食管胃結合部腺癌外科治療中國專家共識(2018年版). 中華胃腸外科雜志, 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.	邱江鋒, 馬欣俐. 食管胃結合部癌分型的思考與爭議: 基于食管浸潤長度的改良分型. 中華消化外科雜志, 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.	中華醫學會外科學分會腹腔鏡與內鏡外科學組. Siewert Ⅱ型食管胃結合部腺癌腔鏡手術治療中國專家共識(2019版). 中國實用外科雜志, 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.	馬海霞, 張勇, 張衛國, 等. Siewert Ⅱ型食管胃結合部腺癌侵犯食管胃結合部黏膜下不同靜脈分區對下縱隔和食管裂孔淋巴結轉移的影響. 中華消化外科雜志, 2023, 22(3): 391-398.
16.	張克昌, 范林廣, 王杰, 等. SiewertⅡ型和Ⅲ型食管胃結合部腺癌下縱隔淋巴結轉移影響因素及轉移規律分析. 中華消化外科雜志, 2022, 21(10): 1370-1375.
17.	胡旭, 鄭佳彬, 許慶文, 等. 手術入路對食管胃結合部腺癌生存預后的影響. 腹腔鏡外科雜志, 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.	中華人民共和國國家衛生健康委員會醫政醫管局. 胃癌診療指南(2022年版). 中華消化外科雜志, 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. 腹腔鏡近端胃切除術治療近端胃癌和食管胃結合部腺癌安全性和近期療效的多中心研究. 中華消化外科雜志, 2023, 22(3): 355-362.
26.	鄒慶濤, 張洪貞, 尹作文, 等. 食管胃結合部腺癌根治術三種消化道重建方式的臨床效果評價. 中華普外科手術學雜志(電子版), 2022, 16(5): 545-548.
27.	戴文鵬, 邱衛明, 王克強, 等. 食管胃結合部癌完全腹腔鏡全胃切除術不同消化道重建方案對比研究. 中華普外科手術學雜志(電子版), 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.	田園, 王強, 王軍, 等. 新輔助同步放化療聯合手術對比直接手術治療Siewert Ⅱ、Ⅲ型食管胃結合部腺癌隨機對照試驗的遠期預后分析. 中華胃腸外科雜志, 2021, 24(2): 128-137.
32.	林佳銳, 莊業忠, 王偉峰, 等. 新輔助化療治療可切除局部晚期食管胃結合部腺癌的療效分析. 中華消化外科雜志, 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. 國際食管疾病學會中國分會(CSDE)食管胃結合部疾病跨界聯盟, 中國醫師協會內鏡醫師分會腹腔鏡外科專業委員會, 中國醫師協會外科醫師分會上消化道外科醫師專業委員會, 等. 食管胃結合部腺癌外科治療中國專家共識(2018年版). 中華胃腸外科雜志, 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. 邱江鋒, 馬欣俐. 食管胃結合部癌分型的思考與爭議: 基于食管浸潤長度的改良分型. 中華消化外科雜志, 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. 中華醫學會外科學分會腹腔鏡與內鏡外科學組. Siewert Ⅱ型食管胃結合部腺癌腔鏡手術治療中國專家共識(2019版). 中國實用外科雜志, 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. 馬海霞, 張勇, 張衛國, 等. Siewert Ⅱ型食管胃結合部腺癌侵犯食管胃結合部黏膜下不同靜脈分區對下縱隔和食管裂孔淋巴結轉移的影響. 中華消化外科雜志, 2023, 22(3): 391-398.
16. 張克昌, 范林廣, 王杰, 等. SiewertⅡ型和Ⅲ型食管胃結合部腺癌下縱隔淋巴結轉移影響因素及轉移規律分析. 中華消化外科雜志, 2022, 21(10): 1370-1375.
17. 胡旭, 鄭佳彬, 許慶文, 等. 手術入路對食管胃結合部腺癌生存預后的影響. 腹腔鏡外科雜志, 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. 中華人民共和國國家衛生健康委員會醫政醫管局. 胃癌診療指南(2022年版). 中華消化外科雜志, 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. 腹腔鏡近端胃切除術治療近端胃癌和食管胃結合部腺癌安全性和近期療效的多中心研究. 中華消化外科雜志, 2023, 22(3): 355-362.
26. 鄒慶濤, 張洪貞, 尹作文, 等. 食管胃結合部腺癌根治術三種消化道重建方式的臨床效果評價. 中華普外科手術學雜志(電子版), 2022, 16(5): 545-548.
27. 戴文鵬, 邱衛明, 王克強, 等. 食管胃結合部癌完全腹腔鏡全胃切除術不同消化道重建方案對比研究. 中華普外科手術學雜志(電子版), 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. 田園, 王強, 王軍, 等. 新輔助同步放化療聯合手術對比直接手術治療Siewert Ⅱ、Ⅲ型食管胃結合部腺癌隨機對照試驗的遠期預后分析. 中華胃腸外科雜志, 2021, 24(2): 128-137.
32. 林佳銳, 莊業忠, 王偉峰, 等. 新輔助化療治療可切除局部晚期食管胃結合部腺癌的療效分析. 中華消化外科雜志, 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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