Browse > Article
http://dx.doi.org/10.5230/jgc.2018.18.e28

Surgical Treatment of Gastroesophageal Junction Cancer  

Hashimoto, Tadayoshi (Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine)
Kurokawa, Yukinori (Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine)
Mori, Masaki (Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine)
Doki, Yuichiro (Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine)
Publication Information
Journal of Gastric Cancer / v.18, no.3, 2018 , pp. 209-217 More about this Journal
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.
Keywords
Gastroesophageal junction cancer; Esophagogastric junction cancer; GEJ; Siewert classification; Paraaortic lymph node dissection;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg 1995;82:346-351.   DOI
2 Yamashita H, Katai H, Morita S, Saka M, Taniguchi H, Fukagawa T. Optimal extent of lymph node dissection for Siewert type II esophagogastric junction carcinoma. Ann Surg 2011;254:274-280.   DOI
3 Fujitani K, Miyashiro I, Mikata S, Tamura S, Imamura H, Hara J, et al. Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia: results of a multicenter study. Gastric Cancer 2013;16:301-308.   DOI
4 Yabusaki H, Nashimoto A, Matsuki A, Aizawa M. Comparison of the surgical treatment strategies for Siewert type II squamous cell carcinoma in the same area as esophagogastric junction carcinoma: data from a single Japanese high-volume cancer center. Surg Today 2014;44:1522-1528.   DOI
5 Mine S, Kurokawa Y, Takeuchi H, Kishi K, Ito Y, Ohi M, et al. Distribution of involved abdominal lymph nodes is correlated with the distance from the esophagogastric junction to the distal end of the tumor in Siewert type II tumors. Eur J Surg Oncol 2015;41:1348-1353.   DOI
6 Hosokawa Y, Kinoshita T, Konishi M, Takahashi S, Gotohda N, Kato Y, et al. Clinicopathological features and prognostic factors of adenocarcinoma of the esophagogastric junction according to Siewert classification: experiences at a single institution in Japan. Ann Surg Oncol 2012;19:677-683.   DOI
7 Pedrazzani C, de Manzoni G, Marrelli D, Giacopuzzi S, Corso G, Minicozzi AM, et al. Lymph node involvement in advanced gastroesophageal junction adenocarcinoma. J Thorac Cardiovasc Surg 2007;134:378-385.   DOI
8 Cense HA, Sloof GW, Klaase JM, Bergman JJ, van Hemert FJ, Fockens P, et al. Lymphatic drainage routes of the gastric cardia visualized by lymphoscintigraphy. J Nucl Med 2004;45:247-252.
9 Hasegawa S, Yoshikawa T, Rino Y, Oshima T, Aoyama T, Hayashi T, et al. Priority of lymph node dissection for Siewert type II/III adenocarcinoma of the esophagogastric junction. Ann Surg Oncol 2013;20:4252-4259.   DOI
10 de Manzoni G, Pedrazzani C, Di Leo A, Bonfiglio M, Tasselli S, Guglielmi A, et al. Metastases to the paraaortic lymph nodes in adenocarcinoma of the cardia. Eur J Surg 2001;167:413-418.   DOI
11 Mine S, Sano T, Hiki N, Yamada K, Nunobe S, Yamaguchi T. Lymphadenectomy around the left renal vein in Siewert type II adenocarcinoma of the oesophagogastric junction. Br J Surg 2013;100:261-266.   DOI
12 Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 2008;359:453-462.   DOI
13 Mariette C, Piessen G, Triboulet JP. Therapeutic strategies in oesophageal carcinoma: role of surgery and other modalities. Lancet Oncol 2007;8:545-553.   DOI
14 Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991;265:1287-1289.   DOI
15 Corley DA, Buffler PA. Oesophageal and gastric cardia adenocarcinomas: analysis of regional variation using the cancer incidence in five continents database. Int J Epidemiol 2001;30:1415-1425.   DOI
16 Holmes RS, Vaughan TL. Epidemiology and pathogenesis of esophageal cancer. Semin Radiat Oncol 2007;17:2-9.   DOI
17 DeMeester SR. Adenocarcinoma of the esophagus and cardia: a review of the disease and its treatment. Ann Surg Oncol 2006;13:12-30.   DOI
18 Lagergren J, Bergstrom R, Lindgren A, Nyren O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999;340:825-831.   DOI
19 Brierley JD, Gospodarowicz MK, Wittekind C, eds. TNM Classification of Malignant Tumours. 8th ed. Hoboken (NJ): Wiley-Blackwell, 2017.
20 Kauppila JH, Lagergren J. The surgical management of esophago-gastric junctional cancer. Surg Oncol 2016;25:394-400.   DOI
21 Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg 1998;85:1457-1459.   DOI
22 Grotenhuis BA, Wijnhoven BP, van Marion R, van Dekken H, Hop WC, Tilanus HW, et al. The sentinel node concept in adenocarcinomas of the distal esophagus and gastroesophageal junction. J Thorac Cardiovasc Surg 2009;138:608-612.   DOI
23 Misumi A, Murakami A, Harada K, Baba K, Akagi M. Definition of carcinoma of the gastric cardia. Langenbecks Arch Chir 1989;374:221-226.   DOI
24 Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011;14:101-112.   DOI
25 Japan Esophageal Society. Japanese Classification of Esophageal Cancer. 2nd ed. Tokyo: Japan Esophageal Society, 2008.
26 Rudiger Siewert J, Feith M, Werner M, Stein HJ. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg 2000;232:353-361.   DOI
27 Kurokawa Y, Hiki N, Yoshikawa T, Kishi K, Ito Y, Ohi M, et al. Mediastinal lymph node metastasis and recurrence in adenocarcinoma of the esophagogastric junction. Surgery 2015;157:551-555.   DOI
28 Yoshikawa T, Takeuchi H, Hasegawa S, Nozaki I, Kishi K, Ito S, et al. Theoretical therapeutic impact of lymph node dissection on adenocarcinoma and squamous cell carcinoma of the esophagogastric junction. Gastric Cancer 2016;19:143-149.   DOI
29 Nunobe S, Ohyama S, Sonoo H, Hiki N, Fukunaga T, Seto Y, et al. Benefit of mediastinal and para-aortic lymph-node dissection for advanced gastric cancer with esophageal invasion. J Surg Oncol 2008;97:392-395.   DOI
30 Yamashita H, Seto Y, Sano T, Makuuchi H, Ando N, Sasako M, et al. Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma. Gastric Cancer 2017;20 Suppl 1:69-83.   DOI
31 Matsumoto S, Takayama T, Wakatsuki K, Enomoto K, Tanaka T, Migita K, et al. Surgical outcomes for cancer at the gastroesophageal junction. Am Surg 2012;78:1285-1291.
32 Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2002;347:1662-1669.   DOI
33 Omloo JM, Lagarde SM, Hulscher JB, Reitsma JB, Fockens P, van Dekken H, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg 2007;246:992-1000.   DOI
34 Sasako M, Sano T, Yamamoto S, Sairenji M, Arai K, Kinoshita T, et al. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol 2006;7:644-651.   DOI
35 Kurokawa Y, Sasako M, Sano T, Shibata T, Ito S, Nashimoto A, et al. Functional outcomes after extended surgery for gastric cancer. Br J Surg 2011;98:239-245.   DOI
36 Kurokawa Y, Sasako M, Sano T, Yoshikawa T, Iwasaki Y, Nashimoto A, et al. Ten-year follow-up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia. Br J Surg 2015;102:341-348.   DOI