ObjectiveTo review and summarize the research progress of adenocarcinoma of esophagogastric junction (AEG) in staging, surgical treatment, endoscopic treatment and adjuvant therapy in recent years, so as to provide reference and help for the follow-up research and treatment of this disease.MethodLiterature review was used to review the literatures on AEG treatment in various databases.ResultsThe incidence of AEG had increased rapidly in recent years, with high malignancy and poor prognosis. Siewert typing had allowed researchers to gain insight into the disease, and treatments were increasingly diversified. At present, the main treatment was still radical surgery. Because AEG was adjacent to the esophagus and stomach, there were many controversies about its staging, surgical approach, resection range, digestive tract reconstruction, adjuvant treatment and so on, especially Siewert type Ⅱ.ConclusionsThe surgical approach, resection range, and laparoscopic surgery of Siewert typeⅡcan choose according to esophageal involvement distance judgment, pathological staging is uncertain, still need several studies to reach a consensus. With the application of laparoscopy and adjuvant therapy, how to select individualized treatment options that require multidisciplinary collaboration for further study.
ObjectivesTo summarize the latest advances about definition, classification, and TNM stage of adenocarcinoma of esophagogastric junction (AEG).MethodThe available guidelines, consensuses, international conference proceedings, and clinical studies were reviewed and summarized.ResultsThe AEG trended to be an independent entity of malignant tumor at the special location. The previous misunderstanding of AEG definitions from the WHO needed to be corrected and unified in China. The Siewert classification was still a practical clinical approach to guiding treatment strategy, while the new draft of JGCA classification needed to be evaluated and verified in the clinical practice. By contrast, the 8th edition AJCC/UICC classification was relatively controversial in the guiding treatment strategies, mainly due to the staging system, surgical approach, and extent of lymphadenectomy of Siewert Ⅱ type AEG. Based on the available research results, the TNM staging system of the 8th edition of gastric cancer tended to be more reasonable for the Siewert Ⅱ and Ⅲ types AEG.ConclusionWith increasing incidence of AEG, more experimental and clinical studies on AEG are ongoing, and it is expected to have more optimized classification and exclusive staging system for AEG in future.
Objective To explore the risk factors of recurrence and metastasis in patients with Siewert Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG) after radical gastrectomy. Methods A retrospective study was conducted to collect the clinical data of 146 patients with type Ⅱ and Ⅲ AEG who underwent radical gastrectomy from January 2010 to January 2013 in the Nanjing First Hospital of Nanjing Medical University. The factors affected the recurrence and metastasis of the patients after the radical gastrectomy were analyzed by the unconditional logistic regression analysis. Results The 146 AEG patients were followed up for 3–84 months, with the median follow-up time of 48 months. During the follow-up period, there were 59 cases suffered from recurrence and metastasis. The recurrence and metastasis time was 1–50 months after radical gastrectomy, with the median time of 17 months after radical gastrectomy. The results of multivariate logistic regression analysis showed that, the histological grade (OR=4.478, P=0.015), the number of positive lymph nodes (OR=2.886, P<0.001), and vascular invasion (OR=5.334, P=0.003) were independent risk factors for the recurrence and metastasis of AEG patients after radical gastrectomy. Patients with low tumor histological grade (G3+G4), a large number of positive lymph nodes, and vascular invasion were more likely to have recurrence and metastasis after radical gastrectomy. Conclusions The histological grade of tissue, number of positive lymph nodes, and vascular invasion are important factors in predicting the recurrence and metastasis of Siewert Ⅱ/Ⅲ AEG patients after radical gastrectomy.
ObjectiveTo compare and analyze the short-term efficacy of different surgical methods for Siewert type Ⅰ and type Ⅱ esophagogastric junction carcinoma.MethodsWe selected 82 patients who accepted radical resection of esophagogastric junction carcinoma from March 2015 to March 2018 in our department, including 53 males and 29 females, aged 48-72 (61±6) years. The patients were divided into four groups according to the surgical method: a left thoracotomy group (n=14), a laparoscopic left small thoracotomy group (n=33), a thoracoscopic Ivor-Lewis group (n=17), and a thoracoscopic McKeown group (n=18). Their clinical characteristics, operative situations, postoperative complications and survival rate were analyzed.ResultsAmong the four groups, the left thoracotomy group cost the shortest operation time, followed by laparoscopic left small thoracotomy group, thoracoscopic McKeown group and thoracoscopic Ivor-Lewis group. The thoracoscopic McKeown group/laparoscopic left small thoracotomy group had the least bleeding. The fewest lymph nodes were dissected in the left thoracotomy group and the most in the thoracoscopic??????? McKeown group. The laparoscopic left small thoracotomy group had the lowest total complication rate and the incidence of pneumonia and arrhythmia among the four groups (P<0.05). There was no significant difference in survival rate among the four groups (P>0.05).ConclusionFor Siewert type Ⅰ and type Ⅱ esophagogastric junction carcinoma, thoracoscopy combined with laparoscopic radical resection is safe and reliable. Laparoscopic left small thoracotomy has the advantages of minimal invasiveness and complete lymph node dissection, especially for the patients with poor cardiopulmonary function, which will significantly shorten operation time and reduce postoperative complications, so it is worth to be popularized.
ObjectiveTo analyze the impact of resection margin length on postoperative clinical outcomes in patients with Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction (AEG) and to investigate the independent risk factors influencing postoperative positive resection margin. MethodsBased on sample size estimation, 173 patients with AEG admitted to the 980th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army from July 2022 to January 2025 were prospectively enrolled and divided into 3 groups according to the proximal resection margin length: <20 mm group, 20–30 mm group, and >30 mm group. Baseline data were compared among the 3 groups, and differences in clinical outcomes among patients with different resection margin lengths were analyzed. Multivariate logistic regression analysis was used to identify independent risk factors for positive resection margin, and receiver operating characteristic (ROC) curve was used to evaluate the discriminative ability of these independent factors for postoperative positive resection margin. Stratified analysis by resection margin length intervals was performed to quantify the association between proximal resection margin length and risk of positive margin, and subgroup analyses were conducted to explore the consistency of this association across different clinicopathologic subgroups. ResultsThere were no statistically significant differences in baseline data such as gender, age among the three groups (P>0.05). Among the three groups, patients in the 20–30 mm group had the shortest operative time and time to first postoperative ambulation (P<0.05), the lowest percentage of body weight loss (P<0.05) and the highest hemoglobin and albumin levels (P<0.05) on postoperative month 6. Multivariate logistic regression analysis showed that tumor length ≥5 cm [OR (95%CI)=4.500 (2.519, 8.038), P=0.008], poorly differentiated pathological type [OR (95%CI)=3.803 (2.098, 6.882), P=0.026], and resection margin length <20 mm or >30 mm [OR (95%CI)=3.997 (1.819, 8.793), P=0.037; OR (95%CI)=4.202 (1.906, 9.252), P=0.031, respectively] were independent risk factors for postoperative positive resection margin. The areas under the ROC curve for these three factors individually and their combination in predicting positive resection margin were 0.765, 0.726, 0.702, and 0.847, respectively. The risk-stratified analysis for positive resection margins revealed that, compared with a superior resection margin length of 20–25 mm, the risk of margin positivity significantly increased at lengths of 15–20 mm and 30–35 mm [OR (95%CI)=6.609 (1.816, 24.034), P=0.004; OR (95%CI)=6.618 (1.832, 23.973), P=0.004]. Subgroup analyses showed that the correlation between resection margin length and positive margin was more pronounced in patients with tumor length ≥5 cm and poorly differentiated pathology (Pinteraction<0.05). ConclusionsFor patients with Siewert type Ⅱ/Ⅲ AEG, maintaining the superior resection margin length within the 20–30 mm range during surgical resection can ensure oncological radicality while optimizing postoperative recovery and nutritional status. For patients with tumor length ≥5 cm and poorly differentiated pathology, greater emphasis should be placed on accurate measurement and frozen section confirmation during surgery.