Chen Longqi, Hu Jiankun, Ji Jiafu, Yu Zhentao
Multidisciplinary Union for Esophagogastric Junction Diseases of Chinese Society for Diseases of the Esophagus (CSDE); Laparoscopic Surgery Committee of the Endoscopist Branch in the Chinese Medical Doctor Association (CMDA); Upper Digestive Tract Surgeons Committee of the Surgeon Branch in the Chinese Medical Doctor Association (CMDA); Gastrointestinal Oncology Group of the Oncology Branch in the Chinese Medical Association (CMA) Email:
Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Sep 25;21(9):961-975.
Incidence of adenocarcinoma of esophago-gastric junction (AEG) in China presents an obviously increasing trend. Due to the particular anatomic site, its definition, classification, staging, surgical approach, resection pattern, extent of lymphadenectomy, and neoadjuvant therapy, etc. remain controversial. The goal of this expert consensus is to improve the homogeneity in understanding and practice among Chinese thoracic and gastrointestinal surgeons, and to further standardize surgical treatment of AEG. This consensus was generated based on the best available clinical evidence, the latest global guidelines or consensuses, and the agreement from the Chinese expert panel. The panel composed of 19 thoracic surgeons and 20 gastrointestinal surgeons nationwide. Delphi technique was used to generate agreement rates and revision details. In the fields of aforementioned controversies, the present consensus produced 27 statements on surgical treatment-related recommendations for AEG, as well as 9 issues as investigational surgical concerns. The present consensus consists of 7 parts:(1) definition and classification of AEG; (2) surgical approach; (3) minimally invasive surgery; (4) pattern and extent of resection; (5) combined organ resection; (6) lymph node group and lymphadenectomy standard; and(7) neoadjuvant therapy. Pending issues in this consensus need further high-quality clinical research.
中国食管胃交界腺癌(AEG)的发病率呈明显上升趋势。由于其特殊的解剖部位,其定义、分类、分期、手术方式、切除模式、淋巴结清扫范围以及新辅助治疗等仍存在争议。本专家共识的目的是提高中国胸外科和胃肠外科医生在认识和实践上的同质性,并进一步规范AEG的外科治疗。本共识基于现有的最佳临床证据、最新的全球指南或共识以及中国专家小组的意见而形成。该小组由全国19名胸外科医生和20名胃肠外科医生组成。采用德尔菲技术得出同意率和修订细节。在上述争议领域,本共识针对AEG的手术治疗相关建议提出了27条声明,以及9个作为研究性手术关注点的问题。本共识共包括7部分:(1)AEG的定义和分类;(2)手术方式;(3)微创手术;(4)切除模式和范围;(5)联合器官切除;(6)淋巴结分组和淋巴结清扫标准;以及(7)新辅助治疗。本共识中的待解决问题需要进一步开展高质量的临床研究。