Minimally invasive surgery in adenocarcinoma of esophagogastric junction / 中华胃肠外科杂志

ABSTRACT

Adenocarcinoma of esophagogastric junction (AEG) is the adenocarcinoma locating in the boundary of esophagus and cardia. Because of its increasing incidence, it has drawn attention widely around the world. In the 11th edition of Japanese Classification of Esophageal Cancer, the diagnosis of AEG should integrate endoscopy, upper gastrointestinal barium contrast and pathology. There are two classifications for AEG, Siewert classification and Nishi classification. In the 8th TNM staging manual, cancer crossing the esophagogastric junction (EGJ) with their epicenter within the proximal 2 cm of the stomach is incorporated into the esophagus chapter, whereas cancer crossing the EGJ with their epicenter in the proximal 2 to 5 cm of the stomach is addressed in the stomach chapter. All the tumors in stomach that do not cross the EGJ are classified as stomach cancer. The surgical approach of AEG remains controversial. Previous researches have suggested that abdominal transhiatal approach should be applied to Siewert type II and III. With respect to minimally invasive surgery, for Siewert I, the mediastinal and abdominal lymphadenectomy is conducted by thoracoscopy and laparoscopy respectively. After that a gastric tube is placed and the reconstruction is performed in the cervix. For Siewert type II, the whole procedure is accessed by laparotomy, and the lower mediastinum is accessed transhiatally. After lymphadenectomy the anastomosis can be laparoscopy-assisted or totally laparoscopic. As for Siewert type III, both circular and linear stapler can be used to perform reconstruction. With the development of surgical technology and continuous renovation of equipment, laparoscopic resection for AEG will be more and more popular.