Advanced Siewert type Ⅱ adenocarcinoma of the esophagogastric junction (AEG) has a unique anatomical location and exhibits heterogeneous biological behavior resembling both esophageal and gastric cancers. It is associated with a high risk of bidirectional lymphatic metastasis to the abdominal cavity and mediastinum, and is often diagnosed at a relatively advanced stage. Therefore, the establishment of precision surgical treatment strategies for this disease remains challenged by several key issues. Based on the latest clinical evidence, guidelines, and expert consensus from China and abroad, and combined with our institutional clinical experience, this article discusses the individualized selection of surgical approaches, precise definition of the extent of lymphadenectomy, safe threshold for the proximal esophageal resection margin, and strategies for digestive tract reconstruction.
