J Gastric Cancer.  2018 Sep;18(3):209-217. 10.5230/jgc.2018.18.e28.

Surgical Treatment of Gastroesophageal Junction Cancer

• Hashimoto
• Kurokawa Y
• Mori M
• Doki Y

• KMID: 2420781
• DOI: http://doi.org/10.5230/jgc.2018.18.e28

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.

Keyword

Gastroesophageal junction cancer; Esophagogastric junction cancer; GEJ; Siewert classification; Paraaortic lymph node dissection

MeSH Terms

Adenocarcinoma
Asian Continental Ancestry Group
Classification
Consensus
Esophageal Neoplasms
Esophagogastric Junction*
Humans
Incidence
Lymph Nodes
Neoplasm Metastasis
Prospective Studies
Retrospective Studies
Stomach Neoplasms

Figure

• 

  Fig. 1 Schema of the Japanese nationwide prospective trial for GEJ cancer. GFJ = gastroesophageal junction; RT = right transthoracic; TH = transhiatal; LN = lymph node; Nos. = numbers.

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