Zhou Yanbing
Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao 266003, China,Email:
Zhonghua Wei Chang Wai Ke Za Zhi. 2019 Feb 25;22(2):112-118.
The incidence of adenocarcinoma of esophagogastric junction (AEG) has been increasing in recent years and has become a major health problem worldwide. The completed phase III clinical trials have revealed that perioperative chemotherapy and radiochemotherapy can significantly improve prognosis and reduce local recurrence in patients with locally advanced AEG. The sudden emergence of targeted therapy and immunotherapy based on chemotherapy has showed a broad prospect. The location and gross type of tumors can provide valuable information for clinical decision making. Siewert classification is widely used in the world, which is helpful to the choice of the best surgical method. Partial gastrectomy and subtotal esophagectomy with thorough mediastinal lymph node dissection via right thorax approach and total gastrectomy with abdominal lymph node dissection are suitable for Siewert types I and III respectively. There is no consensus on the scope of lymph node dissection in Siewert type II procedure and further research is needed. In addition, regarding the rule of abdominal aortic lymph node metastasis and whether it is necessary to clean the para-aortic lymph nodes in patients with AEG, further research is still required.
近年来，食管胃交界腺癌（AEG）的发病率不断上升，已成为全球主要的健康问题。已完成的III期临床试验表明，围手术期化疗和放化疗可显著改善局部晚期AEG患者的预后并减少局部复发。基于化疗的靶向治疗和免疫治疗的突然出现显示出广阔的前景。肿瘤的位置和大体类型可为临床决策提供有价值的信息。Siewert分类在世界范围内广泛应用，有助于选择最佳手术方法。部分胃切除术和经右胸入路彻底纵隔淋巴结清扫的食管次全切除术以及腹主动脉旁淋巴结清扫的全胃切除术分别适用于Siewert I型和III型。对于Siewert II型手术中淋巴结清扫的范围尚无共识，需要进一步研究。此外，关于AEG患者腹主动脉旁淋巴结转移规律以及是否有必要清扫主动脉旁淋巴结，仍需进一步研究。
