Chen L, Liu F L
Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Wai Ke Za Zhi. 2022 Sep 1;60(9):813-818. doi: 10.3760/cma.j.cn112139-20220424-00181.
In recent years, adenocarcinoma of esophagogastric junction (AEG) has received increased attention from the academic community. However, the esophagogastric junction (EGJ) straddles two anatomical regions: the thoracic cavity and the abdominal cavity. The histological features of the EGJ are different from those of the esophagus and stomach. There are general disagreements among the related disciplines regarding the definition and classification of AEG. By summarizing the views of different disciplines, including endoscopy, radiography, and pathology, a more comprehensive definition of the EGJ was formulated in the (the 15th edition), and the principle of endoscopic diagnostic priority was established. In recent years, with the development of physiological and anatomical studies, the EGJ has gradually expanded conceptually into a complex functional anatomical region covering the distal esophagus to the proximal stomach. The venous and lymphatic vessels in the EGJ are characterized by bidirectional flow, which is an important anatomical basis for the invasion and metastasis patterns of tumors in this region. The clinical practice of EGJ cancer has been promoted by the creation of Nishi and Siewert classification systems. With the support of a series of clinical studies for its scientificity and effectiveness, the Siewert classification is widely accepted by the international community, and successively introduced into major international practice guidelines. In general, the staging and management of Siewert Ⅰ and Ⅱ AEG are recommended as esophageal cancer, while Siewert Ⅲ AEG is recommended for gastric cancer. However, in the Japanese guidelines for the treatment of esophageal and gastric cancers, the Nishi classification is still used to define and classify EGJ cancer. Recent year, a Chinese consensus on the surgical treatment of AEG was formulated by multidisciplinary experts. The main controversies were summarized in the consensus, and proposals that incorporate the domestic situation were also presented. At present, only by returning to the basic anatomical and physiological perspectives, strengthening multidisciplinary communication and cooperation, and with the help of emerging bioinformatics, digital, and material technology, can it be possible to get out of the dilemma faced by traditional AEG classification and staging system.
近年来，食管胃交界腺癌（AEG）受到了学术界越来越多的关注。然而，食管胃交界（EGJ）横跨胸腔和腹腔这两个解剖区域。EGJ的组织学特征不同于食管和胃。相关学科对于AEG的定义和分类存在普遍分歧。通过总结包括内镜、放射影像学和病理学等不同学科的观点，在《（第15版）》中制定了更全面的EGJ定义，并确立了内镜诊断优先原则。近年来，随着生理和解剖学研究的发展，EGJ在概念上逐渐扩展为一个覆盖食管远端至胃近端的复杂功能解剖区域。EGJ的静脉和淋巴管具有双向流动的特点，这是该区域肿瘤侵袭和转移模式的重要解剖学基础。Nishi和Siewert分类系统的创立推动了EGJ癌的临床实践。凭借一系列临床研究对其科学性和有效性的支持，Siewert分类被国际社会广泛接受，并相继被引入主要的国际实践指南。一般来说，SiewertⅠ和Ⅱ型AEG的分期和管理建议按照食管癌进行，而SiewertⅢ型AEG则建议按照胃癌进行。然而，在日本食管癌和胃癌治疗指南中，仍使用Nishi分类来定义和分类EGJ癌。近年来，多学科专家制定了中国AEG外科治疗的共识。该共识总结了主要争议点，并提出了结合国内情况的建议。目前，只有回归到基本的解剖和生理视角，加强多学科的沟通与合作，并借助新兴的生物信息学、数字和材料技术，才有可能摆脱传统AEG分类和分期系统所面临的困境。
