[Optimal surgical approach for esophagogastric junction carcinoma]

Esophagogastric junction (EGJ) carcinoma, representing carcinoma involving the anatomical border between the esophagus and stomach, has attracted considerable attention recently because of the marked increase in its incidence. In patients with cancer of the EGJ, comparable outcomes have been obtained with extended esophagectomy and total gastrectomy, and therefore the optimal surgical approach for EGJ tumors remains to be clarified. According to retrospective studies, nodal metastases are frequent in pericardial nodes (no. 1 and no. 2), the lesser curve node (no. 3), and along the left gastric artery node (no. 7), followed by the lower mediastinal paraesophageal node (no. 110) and suprapancreatic nodes (no. 8a, 9, 11p). Nodes along the distal stomach are rarely involved, and therefore total gastrectomy seems unlikely to be justified for prophylactic lymphadenectomy for EGJ carcinoma. Subgroup analysis showed that neither esophagectomy via right thoracotomy nor left thoracoabdominal extended total gastrectomy offered a survival benefit over the transhiatal procedure in Siewert type II carcinoma. Patients with nodal involvement are at high risk of systemic recurrence, and therefore perioperative adjuvant therapy may be as important as the extent of resection in this tumor entity.