Multimodality therapy for adenocarcinoma of the esophagogastric junction

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Author:
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
Issue:
Volume 15, Issue 09, 2012
DOI:
10.3760/cma.j.issn.1671-0274.2012.09.001
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.

  • [1]Vizcaino AP,Moreno V,Lambert R,et al.Time trends incidence of both major histologic types of esophageal carcinomas in selected countries,1973-1995.Int J Cancer,2002,99 (6):860-868.
  • [2]Rüdiger Siewert J,Feith M,Werner M,et al.Adenocarcinoma of the esophagogastric junction:results of surgical therapy based on anatomical/topographic classification in 1002consecutive patients.Ann Surg,2000,232 (3):353-361.
  • [3]Pech O,Behrens A,May A,et al.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.Gut,2008,57(9):1200-1206.
  • [4]Mariette C,Piessen G,Triboulet JP.Therapeutic strategies in oesophageal carcinoma:role of surgery and other modalities.Lancet Oncol,2007,8(6):545-553.
  • [5]Hulscher JB,van Sandick JW,de Boer AG,et al.Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus.N Engl J Med,2002,347 (21):1662-1669.
  • [6]Sasako M,Sano T,Yamamoto S,et al.Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia:a randomised controlled trial.Lancet Oncol,2006,7 (8):644-651.
  • [7]Feith M,Stein HJ,Siewert JR.Adenocarcinoma of the esophagogastric junction:surgical therapy based on 1602 consecutive resected patients.Surg Oncol Clin N Am,2006,15(4):751-764.
  • [8]Sakuramoto S,Sasako M,Yamaguchi T,et al.Adjuvant chemotherapy for gastric cancer with S-1,an oral fluoropyrimidine.N Engl J Med,2007,357(18):1810-1820.
  • [9]De Vita F,Giuliani F,Orditura M,et al.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).Ann Oncol,2007,18(8):1354-1358.
  • [10]Sun P,Xiang JB,Chen ZY.Meta-analysis of adjuvant chemotherapy after radical surgery for advanced gastric cancer.Br J Surg,2009,96(1):26-33.
  • [11]Allum WH,Stenning SP,Bancewicz J,et al.Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer.J Clin Oncol,2009,27 (30):5062-5067.
  • [12]Cunningham D,Allum WH,Stenning SP,et al.Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer.N Engl J Med,2006,355 (1):11-20.
  • [13]Boige V,Pignon J,Saint-Aubert B,et al.Final results of a randomized trial comparing preoperative 5-fl uorouracil (F)/cisplatin (P) to surgery alone in adenocarcinoma of stomach and lower esophagus (ASLE):FNLCC ACCORD07-FFCD 9703trial.Proc Am Soc Clin On col,2007,25:abstr 4510.
  • [14]Thirion PG,Maillard E,Pignon J,et al.Meta-analysis of Chemo in Oesophagus Cancer Collaborative Group.Individual patient databased meta-analysis assessing the effect of preoperative chemoradiotherapy in resectable oesophageal carcinoma.Int J Radiat Oncol Biol Phys,2008,72(suppl):S71-S72.
  • [15]Mariette C,Seitz JF,Maillard E,et al.Surgery alone versus chemoradiotherapy followed by surgery for localized esophageal cancer:analysis of a randomized controlled phase Ⅲ trial FFCD9901.Proc Am Soc Clin Oncol,2010,28:abstr 4005.
  • [16]van Hagen P,Hulshof MC,van Lanschot JJ,et al.Preoperative chemoradiotherapy for esophageal or junctional cancer.N Engl J Med,2012,366(22):2074-2084.
  • [17]Hallissey MT,Dunn JA,Ward LC,et al.The second British Stomach Cancer Group trial of adjuvant radiotherapy or chemotherapy in resectable gastric cancer:five-year follow-up.Lancet,1994,343(8909):1309-1312.
  • [18]Macdonald JS,Benedetti J,Smalley S,et al.Chemoradiation of resected gastric cancer:a 10-year follow-up of the phase Ⅲtrial INT0116 (SWOG 9008).Proc Am Soc Clin Oncol,2009,27:abstr 4515.
  • [19]Stahl M,Walz MK,Stuschke M,et al.Phase Ⅲ comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction.J Clin Oncol,2009,27(6):851-856.
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