Multimodality therapy for adenocarcinoma of the esophagogastric junction

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HE Jie(Department of Thoracic Surgery, Cancer Institute & Hospital,Chinese Academy of Medical Sciences, Beijing 100021,China)
HUANG Jin-feng(Department of Thoracic Surgery, Cancer Institute & Hospital,Chinese Academy of Medical Sciences, Beijing 100021,China)
Journal Title:
Chinese Journal of Gastrointestinal Surgery
Volume 15, Issue 09, 2012
Key Word:
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.

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