He Jie, Huang Jin-feng
Zhonghua Wei Chang Wai Ke Za Zhi. 2012 Sep;15(9):877-80.
The definition of esophagogastric junction (EGJ) adenocarcinoma and progress in multidisciplinary treatment for the tumor were revised in this review. Siewert classification is especially useful for the surgical approach of EGJ adenocarcinoma. Siewert I should be treated as esophageal cancer, and Ivor-Lewis esophagogastrectomy (right thoracotomy and laparotomy) is recommended as an extended two-field lymphadenectomy. For Siewert II or III tumors, left thoracophreno-laparotomy is preferred, especially in case of positive thoracic lymph nodes or positive resection margin. If there is any contraindication against thoracotomy, or a high operating risk, a transhiatal esophagectomy with lower mediastinal lymphadenectomy is an alternative. Preoperative chemoradiotherapy or perioperative chemotherapy improves overall survival and the rate of complete resection for patients with large tumor or lymph node metastasis. Neoadjuvant chemoradiotherapy is associated with high but acceptable postoperative complications. Adjuvant chemoradiotherapy remains a rational standard therapy for curatively resected EGJ cancer with T3 or greater lesion or positive nodes.
本综述对食管胃交界部（EGJ）腺癌的定义及其多学科治疗进展进行了修订。Siewert分类法对EGJ腺癌的手术方式尤为有用。Siewert I型应按食管癌治疗，推荐采用Ivor-Lewis食管胃切除术（右胸切开术和剖腹术）作为扩大的两野淋巴结清扫术。对于Siewert II型或III型肿瘤，首选左胸膈-剖腹术，尤其是在胸段淋巴结阳性或切缘阳性的情况下。如果存在开胸手术的任何禁忌症或手术风险较高，经裂孔食管切除术加下纵隔淋巴结清扫术是一种替代方案。术前放化疗或围手术期化疗可提高大肿瘤或有淋巴结转移患者的总生存率和完全切除率。新辅助放化疗术后并发症发生率较高，但仍在可接受范围内。辅助放化疗仍然是T3期或更严重病变或淋巴结阳性的EGJ癌根治性切除术后合理的标准治疗方法。
