Multimodality therapy for adenocarcinoma of the esophagogastric junction
- Author:
- No author available
- Journal Title:
- Chinese Journal of Gastrointestinal Surgery
- Issue:
- 9
- DOI:
- 10.3760/cma.j.issn.1671-0274.2012.09.001
- Key Word:
- 食管胃交界部腺癌;外科手术;综合治疗;Adenocarcinoma of the esophagogastric junction;Surgical procedure;Combined modality therapy
Abstract： The definition of esophagogastric junction (EGJ) adenocarcinoma and progress in multidisciplinary treatment for the tumor were revised in this review.Siewert classification is especially useful for the surgical approach of EGJ adenocarcinoma.Siewert Ⅰ shoule be treated as esophageal cancer,and Ivor-Lewis esophagogastrectomy (right thoracotomy and laparotomy) is recommended as an extended two-field lymphadenectomy.For Siewert Ⅱ or Ⅲ tumors,left thoracophrenolaparotomy is preferred,especially in case of positive thoracic lymph nodes or positive resection margin.If there is any contraindication against thoracotomy,or a high operating risk,a transhiatal esophagectomy with lower mediastinal lymphadenectomy is an alternative.Preoperative chemoradiotherapy or perioperative chemotherapy improves overall survival and the rate of complete resection for patients with large tumor or lymph node metastasis.Neoadjuvant chemoradiotherapy is associated with high but acceptable postoperative complications.Adjuvant chemoradiotherapy remains a rational standard therapy for curatively resected EGJ cancer with T3 or greater lesion or positive nodes.
- [1]Gebbia V,Romito S,De-Vita F,etc.Adjuvant chemotherapy with epirubicin, leucovorin, 5-fluorouracil and etoposide regimen in resected gastric cancer patients: a randomized phase III trial by the Gruppo Oncologico Italia Meridionale (GOIM 9602 Study).[J].2007,18(8).
- [2]Pech O,Nachbar L,Ell C,etc.Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett's oesophagus.[J].2008,57(9).
- [3]Hiratsuka M,Sasako M,Yamamoto S,etc.Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial.[J].2006,7(8).
- [4]Stuschke M,Lehmann N,Stahl M,etc.Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction.[J].2009,27(6).
- [5]J, Rüdiger Siewert,M, Feith,M, Werner,etc.Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients.[J].2000,232(3).
- [6]Feith M,Stein HJ,Siewert JR.Adenocarcinoma of the esophagogastric junction: surgical therapy based on 1602 consecutive resected patients.[J].2006,15(4).
- [7]van Lanschot JJ,de Boer AG,Fockens P,etc.Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus.[J].2002,347(21).
- [8]Allum WH,Stenning SP,Bancewicz J.Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer.[J].2009,27(30).
- [9]VanHagen,P.,Hulshof,M.C.C.M.,VanLanschot,J.J.B.,etc.Preoperative chemoradiotherapy for esophageal or junctional cancer[J].2012,366(22).
- [10]Cunningham D,Allum WH,Stenning SP,etc.Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer.[J].2006,355(1).
- [11]Sakuramoto S,Sasako M,Yamaguchi T,etc.Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine.[J].2007,357(18).
- [12]Mariette C,Piessen G,Triboulet JP.Therapeutic strategies in oesophageal carcinoma: role of surgery and other modalities.[J].2007,8(6).
- [13]Chen ZY,Sun P,Xiang JB.Meta-analysis of adjuvant chemotherapy after radical surgery for advanced gastric cancer.[J].2009,96(1).
- [14]M T, Hallissey,J A, Dunn,L C, Ward,etc.The second British Stomach Cancer Group trial of adjuvant radiotherapy or chemotherapy in resectable gastric cancer: five-year follow-up.[J].1994,343(8909).