Cancer of the esophagogastric junction |
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| Authors: | Stein H J Feith M Siewert J R |
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| Affiliation: | 1. Department of Civil, Computer, Construction, Environmental Engineering and Applied Mathematics, University of Messina, 98166 Messina, Italy;2. Department DICEAM, University of Reggio Calabria, Via Graziella (Feo Di Vito), 89122 Reggio Calabria, Italy;3. Département de Mathématiques, Université de Perpignan, 66860 Perpignan Cedex, France;1. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada;6. Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada;5. Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada;2. Section of Thoracic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada;3. Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Tex;4. School of Life Sciences, Arizona State University, Tempe, Ariz;7. Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada;1. Department of Gastroenterology, Gastrointestinal cancer unit, Erasme University Hospital, ULB, Brussels, Belgium;2. Department of Pathology, Centro Hospitalar São João/Medical Faculty & Ipatimup/Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal;3. Department of Digestive Oncology, Institut G Roussy, Paris, France;4. III. Medical Department, Clinic Augsburg, Augsburg, Germany;5. University Cancer Center Leipzig (UCCL), University Medicine Leipzig, Leipzig, Germany;6. Gastrointestinal cancer Division, Sloan memorial Kettering Hospital, New York, USA;7. Department of Surgery, Royal Marsden NHS Foundation Trust, London, UK;8. Radiation Oncology, University Hospitals Leuven, Department of Oncology, KU Leuven, Belgium;9. Department of Hepato Gastroenterology and Digestive oncology, University hospital, Univ. Bourgogne Franche-Comté, LNC INSERM UMR866, Dijon, France;10. IMAD, Hepato-Gastroenterology & Digestive Oncology, CHU de Nantes, France;11. Department of Gastroenterology, Netherland Kanker Institute, Amsterdam, Netherlands;12. Department of Gastroenterology,University Hospital, Bochum,Germany;13. Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain;14. Digestive Oncology, University Hospitals Leuven, KU Leuven, Belgium;15. University Paris V René Descartes and University Hospital Hotel Dieu, Nantes, France;p. Department of Internal Medicine I, Ulm University, Ulm, Germany;1. Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet and Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden;2. Department of Oncology and Pathology, Karolinska Institutet and Department of Oncology, Karolinska University Hospital, Stockholm, Sweden |
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| Abstract: | In the Western world, there has been an alarming rise in the incidence and prevalence of adenocarcinoma arising at the esophagogastric junction during recent decades. Epidemiological, clinical and pathological data support a sub-classification of adenocarcinomas arising in the vicinity of the esophagogastric junction (AEG) into adenocarcinoma of the distal esophagus (Type I), true carcinoma of the cardia (Type II) and subcardial carcinoma (Type III). While most, if not all, adenocarcinomas of the distal esophagus arise from areas with specialized intestinal metaplasia, which develop as a consequence of chronic gastroesophageal reflux, the etiology and pathogenesis of true carcinoma of the gastric cardia and subcardial gastric cancer is not clear at present. Although a subgroup of true carcinomas of the gastric cardia may also develop within short segments of intestinal metaplasia at the esophagogastric junction, a causal relation between these tumors and gastroesophageal reflux has been difficult to establish. Irrespective of the etiology, a complete removal of the primary tumor and its lymphatic drainage has to be the primary goal of any surgical approach to adenocarcinoma of the esophagogastric junction. Our experience in the management of more than 1000 such patients during the past 18 years suggests that an individualized therapeutic strategy oriented by tumor type and stage results in survival rates superior to those reported with a more indiscriminate approach. This individualized strategy prescribes a transmediastinal esophagectomy with lymphadenectomy in the lower posterior mediastinum and along the celiac axis for Type I tumors, extended total gastrectomy with transhiatal resection of the distal esophagus and D2 lymphadenectomy for Type II and Type III tumors, a limited resection of the esophagogastric junction and distal esophagus with interposition of a pedicled jejunal segment for uT1N0 tumors, and neoadjuvant chemotherapy followed by resection for uT3/T4 tumors. Extensive preoperative staging is essential to allow correct selection of the appropriate therapeutic strategy using this tailored approach. |
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