[Treatment Strategy for Esophagogastric Junction Carcinoma;Highly Controversial Topic in the Upper Gastrointestinal Malignancy]

Among the 3 subtypes of adenocarcinoma of the esophagogastric junction (AEG), Siewert type I is basically consistent with esophageal adenocarcinoma arising from the Barrett epithelium( Barrett's adenocarcinoma), and type III is gastric carcinoma with esophageal invasion over the esophagogastric junction(EGJ). It is generally endorsed that type I is treated as an esophageal carcinoma, and type III as a gastric carcinoma. Siewert type II carcinoma, located just at the borderline between the esophagus and the stomach, has been a highly controversial topic regarding surgical approach, extent of esophagogastric resection and lymphadenectomy, type of reconstruction, and even the staging system. Type I is predominant in western countries and has been sharply increasing over the past 2 decades. Meanwhile, types II and III are common subtypes in Asian countries where the incidence of gastric carcinoma has long been very high. Current state of AEG and relevant issues are reviewed in this article.