ABSTRACT
The incidence of adenocarcinoma of the esophagogastric junction (AEG) has been increasing worldwide, which attracts great attention among medical professionals because of its anatomical location and unique biological behavior. Although some consensus has been reached regarding the pathogenesis and classification of AEG, there remain debates about its surgical treatment, including the surgical route, scope of gastrectomy, range of lymph node dissection, and digestive tract reconstruction. These debates limit the exploration and development of AEG treatment and make it difficult to standardize the diagnosis and treatment of AEG. This study reviews the relevant literature on AEG in recent years and comprehensively discusses the current consensus and controversy regarding the treatment of AEG with the aim to provide a more reasonable and effective method for its clinical diagnosis and treatment.
ABSTRACT
The prognosis of gastroesophageal junction cancer is relatively poor given its special location and biological behavior. Surgery is the main treatment for adenocarcinoma of esophagogastric junction (AEG), but there is no consensus on the surgical method in different Siewert types. Based on the NCCN guideline and large-scale study results, this review believes that thoracogastroesophageal gastrectomy may benefit patients with Siewert type. In contrast, for patients with Siewert III, partial or total gastrectomy is recommended. However, for Siewert Ⅱ patients, for surgical method we should consider tumor stage, tumor size, distance from the distal end to the junction of the stomach and esophagus, and other factors. No matter which surgical method is selected, R0 resection and thorough lymph node dissection are the most important factors affecting the prognosis. In addition, perioperative chemoradiotherapy or chemotherapy following surgery and adjuvant chemotherapy can benefit some patients at local regional advanced stage. For patients at advanced stage, targeted therapy and immunotherapy are an option of treatment.