Tomi Yoshiaki, Kinoshita Takahiro, Yura Masahiro, Sakamoto Naoya, Fujita Takeo, Tokunaga Masanori, Kinugasa Yusuke
Department of Gastric Surgery, National Cancer Center Hospital East, 6-5-1 Kahiwanoha, Kashiwa, 277-8577, Japan.
Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan.
Surg Today. 2025 Jun;55(6):768-777. doi: 10.1007/s00595-024-02955-2. Epub 2024 Nov 5.
The incidence of esophagogastric junction (EGJ) adenocarcinoma has increased worldwide. As the EGJ is located at the boundary between the thoracic and abdominal cavities, the optimal surgical approach is a subject of debate and estimation of the esophageal invasion length (EIL) is an important factor in its selection.
Data from our in-house database were extracted for consecutive patients with Siewert type I, II and III EGJ adenocarcinoma (EIL ≤ 4 cm), who underwent transhiatal or transthoracic surgical resection between 2010 and 2016. The clinical records of these patients were reviewed and the accuracy of EIL estimation and its discrepancy with the pathological measurement were analyzed.
A total of 82 patients were included in the final analysis. We established that EIL was underestimated in 49 of these patients (59.8%). The mean-distance discrepancy between the preoperative and pathological diagnosis of EIL in the underestimation group was 7.0 mm. Multivariate analysis revealed that submucosal cancer spread was an independent risk factor for underestimation (P < 0.01). The mean length of submucosal cancer spread was longer for undifferentiated histologic type EGJ adenocarcinomas. (P < 0.01).
The EIL was underestimated in approximately 60% of EGJ adenocarcinomas requiring surgical treatment. Thus, careful management is necessary, especially for EGJ adenocarcinoma of the undifferentiated histologic type.
食管胃交界部（EGJ）腺癌的发病率在全球范围内呈上升趋势。由于EGJ位于胸腔和腹腔的交界处，最佳手术方式存在争议，而食管浸润长度（EIL）的评估是手术方式选择的重要因素。
从我们的内部数据库中提取2010年至2016年间连续接受经裂孔或经胸手术切除的Siewert I型、II型和III型EGJ腺癌（EIL≤4 cm）患者的数据。回顾这些患者的临床记录，分析EIL评估的准确性及其与病理测量的差异。
最终分析共纳入82例患者。我们发现其中49例患者（59.8%）的EIL被低估。低估组术前和病理诊断的EIL平均距离差异为7.0 mm。多因素分析显示，黏膜下癌扩散是低估的独立危险因素（P<0.01）。未分化组织学类型的EGJ腺癌黏膜下癌扩散的平均长度更长（P<0.01）。
在大约60%需要手术治疗的EGJ腺癌中，EIL被低估。因此，需要谨慎处理，尤其是对于未分化组织学类型的EGJ腺癌。
