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Esophagogastric junction adenocarcinomas: individualization of resection with special considerations for Siewert type II, and Nishi types EG, E=G and GE cancers

Gastric Cancer. 2020 Jan;23(1):3-9. doi: 10.1007/s10120-019-01022-x. Epub 2019 Nov 6.

Abstract

For Siewert type II adenocarcinoma of the esophagogastric junction (AEG II), or similar tumors classified as Nishi EG, E=G, GE, the type of surgical resection and reconstruction should be individualized. Criteria for decision making mainly focus on the oral extent of esophageal infiltration, the cT and cN category and the functional status of the patient. For cT1/cT2 adenocarcinomas, which are non-poorly cohesive, intestinal type of Lauren Grading 1 or 2 without clinical signs of lymph node metastasis at the distal stomach, a limited transhiatal proximal gastrectomy with double tract reconstruction is recommended. For advanced adenocarcinomas, subtotal esophageal and proximal gastric resection with gastric pull-up or distal esophageal resection with total gastrectomy and esophagojejunostomy are competing procedures. Criteria for choosing the appropriate type of surgery are discussed.

Keywords: Adenocarcinoma of the esophagogastric junction; Esophageal cancer; Gastric cancer; Nishi classification; Siewert classification.

Publication types

  • Review

MeSH terms

  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery*
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / surgery*
  • Esophagectomy / methods
  • Esophagogastric Junction / pathology
  • Gastrectomy / methods
  • Humans
  • Lymphatic Metastasis / pathology
  • Plastic Surgery Procedures
  • Precision Medicine
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / surgery*

Supplementary concepts

  • Adenocarcinoma Of Esophagus