Surgical Treatment of Gastroesophageal Junction Cancer

Abstract

Although the incidence of gastroesophageal junction (GEJ) adenocarcinoma has been increasing worldwide, no standardized surgical strategy for its treatment has been established. This study aimed to provide an update on the surgical treatment of GEJ adenocarcinoma by reviewing previous reports and propose recommended surgical approaches. The Siewert classification is widely used for determining which surgical procedure is used, because previous studies have shown that the pattern of lymph node (LN) metastasis depends on tumor location. In terms of surgical approaches for GEJ adenocarcinoma, a consensus was reached based on two randomized controlled trials. Siewert types I and III are treated as esophageal cancer and gastric cancer, respectively. Although no consensus has been reached regarding the treatment of Siewert type II, several retrospective studies suggested that the optimal treatment strategy includes paraaortic LN dissection. Against this background, a Japanese nationwide prospective trial is being conducted to determine the proportion of LN metastasis in GEJ cancers and to identify the optimal extent of LN dissection in each type.

Treatment Alternatives for Recurrent Esophagogastric Junction Adenocarcinoma: Case Report of an Ileocolonic Reconstruction and Literature Review

“…The endoscopic study is the fundamental pillar to define the best treatment for patients with EGJ lesions since defining the exact location predicts patterns of lymph node metastasis [7]. In this initial study, the length of the tumor, the involvement of the circumference, and the location of the squamous-columnar junction are always defined, which vary according to the height of the patient.…”

“…Lymph node involvement in all oncological pathologies, as well as in EGJ tumors, is a prognostic factor for overall recurrence and survival rates. These tumors have the particularity that lymphatic drainage pathways include both the abdomen and the mediastinum [7]. In radical surgery, both the primary tumor and lymphatic drainage must be resected, taking into account that 16% of these tumors involve lymph nodes in the lower mediastinum [11].…”

Thoraco-laparoscopic Ivor-Lewis esophagectomy: the most extensive Indian experience

“…Various minimally invasive approaches that include trans-hiatal, McKeown's, and Ivor Lewis are increasingly being used given a significant reduction in the pulmonary morbidity involved with their open counterparts. For adenocarcinoma of the distal esophagus and EGJ lesions, proximal gastrectomy with subtotal esophagectomy and intrathoracic anastomosis or total gastrectomy with lower mediastinal lymph node dissection is the surgical treatment [4] . Ivor Lewis esophagectomy (ILE) including thoracotomy and laparotomy [5] was the commonly performed surgery and now minimally invasive ILE including thoracoscopy and laparoscopy, has gained popularity [6] .…”

Aggressive Graphic/Surgical R0 Resection and Jejunal Interposition with Preservation of Mesojejunal Autonomic Nerves in Patients with Stage IV Esophagogastric Junction Adenocarcinoma: A Report of 3 Cases

“…The incidence of esophagogastric junction adenocarcinoma has been increasing worldwide [1]. However, a standardized surgical strategy for treatment of esophagogastric junction cancer (EGJC) has not been established [1]. Although optimal lymph node (LN) dissection in the treatment of EGJC is still controversial, the hiatal LNs (No.…”