食管胃交界部腺癌的综合治疗

本文对食管胃交界部腺癌的以手术为主的综合治疗的进展进行了全面的复习和总结，Siewert分型对于食管胃交界区域腺癌的手术人路选择比较实用。时于SiewertI型（实际为食管胸下段癌）．目前国内外观点趋于一致．应按食管癌TNM分期标准．首选Ivor—Lewis手术．行扩大二野淋岜结清扫．对于SiewertⅡ型（实际为贲门癌）应选择经左后外切口开胸开膈行食管胃部分切除．但当患者年龄偏大或身体条件差时．可以考虑选择经腹和扩大食管裂孔行食管胃部分切除。SiewertⅢ型（胃癌）．可以考虑选择经腹和扩大食管裂孔或左后外切口开胸开膈行食管胃部分切除．尤其考虑胸腔有可疑淋巴结转移或肿瘤累及EGJ以上食管可能导致上切缘阳性时．要考虑选择左后外切口开胸开膈行食管胃部分切除。围手术期化疗或术前同步放化疗对提高手术切除率或生存率有益．因此．对于肿瘤较大或有明硅淋巴结转移的患者可以考虑术前化疗或同步放化疗以提高R0手术切除率和长期生存．但术前同步放化疗会增加手术并发症风险。术后辅助治疗首选同步放化疗。

Multimodality therapy for adenocarcinoma of the esophagogastric junction

The definition of esophagogastric junction （EGJ） adenoeawinoma and progress in multidiseiplinary treatment for the tumor were revised in this review. Siewert classification is especially useful for the surgical approach of EGJ adenocareinoma. Siewert I shoule be treated as esophageal cancer, and lvor-Lewis esophagogastrectomy （right thoracotomy and laparotomy） is recommended as an extended two-fieht lymphadenectomy. For Siewert Ⅱ Mr Ⅲ tumors, left thoracophrenolaparotomy is preferred, especially in case of positive thoraeic lymph nodes or positive resection margin. If there is anv eontraindication against thoracotomy, or a high operating risk, a transhiatal esophageetomy with lower mediastinal lymphadenectomy is an ahernative. 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 ehemoradiotherapy remains a rational standard therapy for curatively resected EGJ cancer with T3 or greater lesion or positive nodes.