Treatment approaches to esophagogastric junction tumors

Esophagogastric junction (EGJ) adenocarcinomas are usually classified into one of the three categories of the Siewert system. The clinicopathological features of EGJ adenocarcinomas vary according to this classification scheme. The lymphatic flow in EGJ tumors of any type is mainly toward the abdomen, and nodal metastasis to the upper or middle mediastinum from Siewert type II or III tumors is relatively uncommon. Thus, the transhiatal approach is regarded as the standard in surgery for Siewert type II or III tumors, while the transthoracic approach via a right thoracotomy is recommended for Siewert type I tumors. Chemoradiotherapy followed by surgery is regarded as the standard treatment for resectable cancer of the EGJ in Western countries, but the necessity of adding radiation therapy to preoperative chemotherapy remains unknown. In the East, postoperative adjuvant chemotherapy is the current standard of care since the survival benefit was proven in pivotal randomized trials for stage II/III gastric cancer, including adenocarcinoma of the EGJ.