[Conversion surgery strategy for adenocarcinoma of the esophagogastric junction]

The incidence of adenocarcinoma of the esophagogastric junction (AEG) continues to rise, with 20%-30% of patients initially diagnosed with stage IV disease, for whom conventional palliative treatment offers limited efficacy. Conversion therapy based on a multidisciplinary team (MDT) approach has brought hope for achieving curative-intent R0 resection in these patients. Existing evidence suggests that patients who achieve tumor response following conversion therapy may gain prolonged postoperative survival through R0 resection, thereby converting the disease from "incurable" to "potentially curable." However, the success of conversion therapy presents new challenges for surgical decision-making. Moreover, this field is still in its early exploratory stage, with a lack of high-level evidence-based medicine, underscoring the urgent need for further research to standardize and guide clinical practice. This article aims to systematically discuss surgical strategies for AEG after conversion therapy by integrating current evidence and clinical practice, focusing on core issues including the value of surgery, surgical indications, timing of surgery, surgical approach and technique, extent of tumor resection, lymph node dissection, and management of special scenarios such as liver, lung, or peritoneal metastases, in order to provide a reference for establishing standardized and precise conversion surgery strategies for AEG.