Department of Digestive and Oncological Surgery, University Hospital C. Huriez, Centre Hospitalier Régional Universitaire, Place de Verdun, 59037 Lille Cedex, France.
J Visc Surg. 2012 Feb;149(1):e23-33. doi: 10.1016/j.jviscsurg.2012.01.003. Epub 2012 Feb 16.
While the prevalence of distal gastric cancer is decreasing in the western world, there has been an alarming rise in the incidence of esophagogastric junction adenocarcinoma (EGJA) during recent decades. Current reports show that the prognosis of EGJA remains poor. Therapy strategies are complex due to the anatomical location of the junction between the esophagus and stomach. Surgery, based on Siewert's classification and associated with regional lymphadenectomy, is the mainstay of treatment. Transthoracic esophagectomy is recommended for type I EGJA, while total gastrectomy is recommended for type III EGJA; both approaches can be considered for type II EGJA. Surgery alone can be indicated only for stage I and IIa tumors. Perioperative chemotherapy should be considered for stage IIb, III and non-metastatic stage IV tumors. Adjuvant chemoradiation can be proposed for tumors with high-risk of recurrence in the absence of neoadjuvant therapy. Neoadjuvant chemoradiation can be proposed for predominantly esophageal EGJA, and might well become a standard treatment for all EGJA tumors in the near future. A multidisciplinary approach is essential for optimal diagnosis and management.
虽然在西方世界，远端胃癌的发病率正在下降，但在最近几十年，胃食管交界处腺癌（EGJA）的发病率却惊人地上升。目前的报告显示，EGJA 的预后仍然很差。由于食管和胃交界处的解剖位置，治疗策略较为复杂。基于 Siewert 分类的手术，以及相关的区域淋巴结清扫术，是主要的治疗方法。I 型 EGJA 推荐经胸食管切除术，III 型 EGJA 推荐全胃切除术；II 型 EGJA 可考虑这两种方法。仅手术可用于 I 期和 IIa 期肿瘤。对于 IIb、III 期和非转移性 IV 期肿瘤，应考虑围手术期化疗。对于无新辅助治疗的高复发风险肿瘤，可以提出辅助放化疗。对于主要为食管 EGJA 的肿瘤，可以提出新辅助放化疗，并且可能在不久的将来成为所有 EGJA 肿瘤的标准治疗方法。多学科方法对于最佳诊断和管理至关重要。
