Research progress of adenocarcinoma of esophago-gastric junction_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Yong ¹ , LI Weiping ² , LIAO Zongyuan ¹ , XIONG Hui ¹ ,  ZHANG Jiangnan ¹

1. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, P.R.China;
2. Department of Gastrointestinal Surgery, The First People’s Hospital of Taicang, Taicang, Jiangsu 215400, P.R.China;

Corresponding?author：

ZHANG Jiangnan, Email: zjnss@sina.com

Keywords：

adenocarcinoma of esophago-gastric junction; Siewert classification; lymph node metastasis; surgical procedure; chemotherapy

DOI：

10.7507/1007-9424.201609058

Video：

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Objective To summarize the research progress of the adenocarcinoma of esophago-gastric junction (AEG) in recent years, in order to improve the further understanding of this disease. Method The literatures about application and research progress of AEG were researched and reviewed. Results Siewert classification was a widely recognized classification for AEG, according to this classification, AEG was divided into typeⅠ, Ⅱ, and Ⅲ. Gastroesophageal reflux, Barrett’ sesophagus, and the infection of Helicobacter pylori may be the important pathogenic factors. For SiewertⅠAEG, thoracic approach was preferred commonly, and for SiewertⅡand Ⅲ AEG, total gastrectomy through abdominal approach and distal partial resection of esophagus through diaphragmatic hiatus approach were recommended. Endoscopic submucosal resection, neoadjuvant therapy, targeted therapy, and multidisciplinary team were becoming more and more important in the treatment of AEG. Conclusions The choice of surgical method and resection range should according to the types of AEG. Comprehensive assessment and comprehensive treatment would be performed, so that effect of treatment may be improved.

Citation： YANG Yong, LI Weiping, LIAO Zongyuan, XIONG Hui, ZHANG Jiangnan. Research progress of adenocarcinoma of esophago-gastric junction. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(6): 765-769. doi: 10.7507/1007-9424.201609058 Copy

1.	Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3^rd English edition. Gastric Cancer, 2011, 14(2): 101-112.
2.	Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg, 1998, 85(11): 1457-1459.
3.	胡祥. 日本《胃癌治療指南》(第 3 版)解讀. 中國實用外科雜志, 2010, 30(1): 25-30.
4.	Wu A, Ji J. Adenocarcinoma of esophagogastric junction requires a clearer definition. Transl Gastrointest Cancer, 2013, 2 Supplement 1: 5-9.
5.	胡祥. 2014 年第 4 版日本《胃癌治療指南》更新要旨. 中國實用外科雜志, 2015, 35(1): 16-19.
6.	Dolan K, Morris AI, Gosney JR, et al. Three different subsite classification systems for carcinomas in the proximity of the GEJ, but is it all one disease? J Gastroenterol Hepatol, 2004, 19(1): 24-30.
7.	封巍, 鄭曉. 食管胃交界部腫瘤的綜合治療. 2013 華東胸部腫瘤論壇暨浙江省胸部腫瘤論壇, 浙江省, 2013: 34-44.
8.	Orditura M, Galizia G, Lieto E, et al. Treatment of esophagogastric junction carcinoma: an unsolved debate. World J Gastroenterol, 2015, 21(15): 4427-4431.
9.	Liu K, Yang K, Zhang W, et al. Changes of esophagogastric junctional adenocarcinoma and gastroesophageal reflux disease among surgical patients during 1988-2012: a single-institution, high-volume experience in China. Ann Surg, 2016, 263(1): 88-95.
10.	Buas MF, Vaughan TL. Epidemiology and risk factors for gastroesophageal junction tumors: understanding the rising incidence of this disease. Semin Radiat Oncol, 2013, 23(1): 3-9.
11.	中華醫學會消化病學分會. Barrett 食管診治共識(2011 修訂版, 重慶). 中華消化內鏡雜志, 2011, 28(8): 421-422.
12.	Runge TM, Abrams JA, Shaheen NJ. Epidemiology of Barrett’s esophagus and esophageal adenocarcinoma. Gastroenterol Clin North Am, 2015, 44(2): 203-231.
13.	Strong VE, Wu AW, Selby LV, et al. Differences in gastric cancer survival between the U. S. and China. J Surg Oncol, 2015, 112(1): 31-37.
14.	Rubenstein JH, Inadomi JM, Scheiman J, et al. Association between Helicobacter pylori and Barrett’s esophagus, erosive esophagitis, and gastroesophageal reflux symptoms. Clin Gastroenterol Hepatol, 2014, 12(2): 239-245.
15.	閔國清, 謝丹, 孔德釗. 巴雷特食管臨床分析. 中華消化病與影像雜志(電子版), 2014, 4(1): 31-33.
16.	汪萍波. Hp 感染與胃癌相關性的臨床研究. 浙江臨床醫學, 2010, 12(10): 1105-1106.
17.	常廷民, 李建生, 李秀敏. 賁門癌與幽門螺桿菌感染的相關性研究. 中華醫院感染學雜志, 2013, 23(6): 1464-1466.
18.	Mitchell D, Derakhshan M, Wirz A, et al. PWE-071 the majority of H. Pylori infected subjects have reduced intragastric acidity and parietal cell density which is most marked close to the gastroesophageal junction. Gut, 2016, 65(Suppl 1): A172-A173.
19.	Feith M, Stein HJ, Siewert JR. Adenocarcinoma of the esophagogastric junction: surgical therapy based on 1 602 consecutive resected patients. Surg Oncol Clin N Am, 2006, 15(4): 751-764.
20.	陳凜, 張士武. 食管胃結合部腺癌淋巴結轉移規律及其對臨床指導意義. 中國實用外科雜志, 2012, 32(4): 277-280.
21.	季加孚, 季鑫. 食管胃結合部腺癌的外科治療. 中華消化外科雜志, 2014, 13(2): 81-84.
22.	Hulscher JB, van Sandick JW, de Boer AG, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med, 2002, 347(21): 1662-1669.
23.	Khullar OV, Jiang R, Force SD, et al. Transthoracic versus transhiatal resection for esophageal adenocarcinoma of the lower esophagus: a value-based comparison. J Surg Oncol, 2015, 112(5): 517-523.
24.	Kurokawa Y, Sasako M, Sano T, et al. Ten-year follow-up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia. Br J Surg, 2015, 102(4): 341-348.
25.	馬小明, 吳建強, 王建. 食管胃結合部腺癌的研究進展. 中國普外基礎與臨床雜志, 2015, 22(5): 637-641.
26.	Zheng Z, Cai J, Yin J, et al. Transthoracic versus abdominal-transhiatal resection for treating Siewert typeⅡ/Ⅲadenocarcinoma of the esophagogastric junction: a meta-analysis. Int J Clin Exp Med, 2015, 8(10): 17167-17182.
27.	黃雷, 徐阿曼, 韓文秀, 等. SiewertⅡ 型和 Ⅲ 型食管胃結合部腺癌全胃與近端胃切除術的療效比較. 中華消化外科雜志, 2014, 13(2): 110-114.
28.	Takeuchi H, Kitagawa Y. Adenocarcinoma of the esophagogastric junction: territory of the esophagus or stomach, or an independent region? Ann Surg Oncol, 2013, 20(3): 705-706.
29.	Masuzawa T, Takiguchi S, Hirao M, et al. Comparison of perioperative and long-term outcomes of total and proximal gastrectomy for early gastric cancer: a multi-institutional retrospective study. World J Surg, 2014, 38(5): 1100-1106.
30.	Nozaki I, Hato S, Kobatake T, et al. Long-term outcome after proximal gastrectomy with jejunal interposition for gastric cancer compared with total gastrectomy. World J Surg, 2013, 37(3): 558-564.
31.	趙群, 姚繼方, 李勇, 等. SiewertⅡ、Ⅲ 型食管胃結合部腺癌兩種外科手術入路治療效果的研究. 腹部外科, 2013, 26(4): 238-240.
32.	Takiguchi N, Takahashi M, Ikeda M, et al. Long-term quality-of-life comparison of total gastrectomy and proximal gastrectomy by postgastrectomy syndrome assessment scale (PGSAS-45): a nationwide multi-institutional study. Gastric Cancer, 2015, 18(2): 407-416.
33.	鄭國良, 鄭志超, 趙巖, 等. 根治性胃切除術治療 SiewertⅡ 和 Ⅲ 型食管胃結合部腺癌的療效分析. 中華腫瘤雜志, 2016, 38(7): 538-542.
34.	白順滟, 肖思潔, 吳俊超, 等. 內鏡黏膜下剝離術和黏膜切除術治療早期胃癌的臨床對比分析. 中國內鏡雜志, 2014, 20(8): 873-877.
35.	Namasivayam V, Wang KK, Prasad GA. Endoscopic mucosal resection in the management of esophageal neoplasia: current status and future directions. Clin Gastroenterol Hepatol, 2010, 8(9): 743-754.
36.	Ronellenfitsch U, Schwarzbach M, Hofheinz R, et al. Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus. Cochrane Database Syst Rev, 2013, 5(5): 1-88.
37.	Kumagai K, Rouvelas I, Tsai JA, et al. Survival benefit and additional value of preoperative chemoradiotherapy in resectable gastric and gastro-oesophageal junction cancer: a direct and adjusted indirect comparison meta-analysis. Eur J Surg Oncol, 2015, 41(3): 282-294.
38.	Shapiro J, van Lanschot JJ, Hulshof MC, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol, 2015, 16(9): 1090-1098.
39.	Narita T, Seshimo A, Suzuki M, et al. Status of tissue expression and serum levels of HER2 in gastric cancer patients in Japan. Hepatogastroenterology, 2013, 60(125): 1083-1088.
40.	王士娜, 馬靜, 楊立宇, 等. HER2/neu 和 Akt2 在胃癌中的表達及意義. 中國醫科大學學報, 2013, 42(2): 131-134.
41.	Soularue é, Cohen R, Tournigand C, et al. Efficacy and safety of trastuzumab in combination with oxaliplatin and fluorouracil-based chemotherapy for patients with HER2-positive metastatic gastric and gastro-oesophageal junction adenocarcinoma patients: a retrospective study. Bull Cancer, 2015, 102(4): 324-331.
42.	徐澤寬. 2015 年 V1 版《NCCN 胃癌臨床實踐指南》更新解讀. 中國實用外科雜志, 2015, (5): 512-514.
43.	Okines A, Verheij M, Allum W, et al. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2010, 21 Suppl 5: v50-v54.

1. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3^rd English edition. Gastric Cancer, 2011, 14(2): 101-112.
2. Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg, 1998, 85(11): 1457-1459.
3. 胡祥. 日本《胃癌治療指南》(第 3 版)解讀. 中國實用外科雜志, 2010, 30(1): 25-30.
4. Wu A, Ji J. Adenocarcinoma of esophagogastric junction requires a clearer definition. Transl Gastrointest Cancer, 2013, 2 Supplement 1: 5-9.
5. 胡祥. 2014 年第 4 版日本《胃癌治療指南》更新要旨. 中國實用外科雜志, 2015, 35(1): 16-19.
6. Dolan K, Morris AI, Gosney JR, et al. Three different subsite classification systems for carcinomas in the proximity of the GEJ, but is it all one disease? J Gastroenterol Hepatol, 2004, 19(1): 24-30.
7. 封巍, 鄭曉. 食管胃交界部腫瘤的綜合治療. 2013 華東胸部腫瘤論壇暨浙江省胸部腫瘤論壇, 浙江省, 2013: 34-44.
8. Orditura M, Galizia G, Lieto E, et al. Treatment of esophagogastric junction carcinoma: an unsolved debate. World J Gastroenterol, 2015, 21(15): 4427-4431.
9. Liu K, Yang K, Zhang W, et al. Changes of esophagogastric junctional adenocarcinoma and gastroesophageal reflux disease among surgical patients during 1988-2012: a single-institution, high-volume experience in China. Ann Surg, 2016, 263(1): 88-95.
10. Buas MF, Vaughan TL. Epidemiology and risk factors for gastroesophageal junction tumors: understanding the rising incidence of this disease. Semin Radiat Oncol, 2013, 23(1): 3-9.
11. 中華醫學會消化病學分會. Barrett 食管診治共識(2011 修訂版, 重慶). 中華消化內鏡雜志, 2011, 28(8): 421-422.
12. Runge TM, Abrams JA, Shaheen NJ. Epidemiology of Barrett’s esophagus and esophageal adenocarcinoma. Gastroenterol Clin North Am, 2015, 44(2): 203-231.
13. Strong VE, Wu AW, Selby LV, et al. Differences in gastric cancer survival between the U. S. and China. J Surg Oncol, 2015, 112(1): 31-37.
14. Rubenstein JH, Inadomi JM, Scheiman J, et al. Association between Helicobacter pylori and Barrett’s esophagus, erosive esophagitis, and gastroesophageal reflux symptoms. Clin Gastroenterol Hepatol, 2014, 12(2): 239-245.
15. 閔國清, 謝丹, 孔德釗. 巴雷特食管臨床分析. 中華消化病與影像雜志(電子版), 2014, 4(1): 31-33.
16. 汪萍波. Hp 感染與胃癌相關性的臨床研究. 浙江臨床醫學, 2010, 12(10): 1105-1106.
17. 常廷民, 李建生, 李秀敏. 賁門癌與幽門螺桿菌感染的相關性研究. 中華醫院感染學雜志, 2013, 23(6): 1464-1466.
18. Mitchell D, Derakhshan M, Wirz A, et al. PWE-071 the majority of H. Pylori infected subjects have reduced intragastric acidity and parietal cell density which is most marked close to the gastroesophageal junction. Gut, 2016, 65(Suppl 1): A172-A173.
19. Feith M, Stein HJ, Siewert JR. Adenocarcinoma of the esophagogastric junction: surgical therapy based on 1 602 consecutive resected patients. Surg Oncol Clin N Am, 2006, 15(4): 751-764.
20. 陳凜, 張士武. 食管胃結合部腺癌淋巴結轉移規律及其對臨床指導意義. 中國實用外科雜志, 2012, 32(4): 277-280.
21. 季加孚, 季鑫. 食管胃結合部腺癌的外科治療. 中華消化外科雜志, 2014, 13(2): 81-84.
22. Hulscher JB, van Sandick JW, de Boer AG, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med, 2002, 347(21): 1662-1669.
23. Khullar OV, Jiang R, Force SD, et al. Transthoracic versus transhiatal resection for esophageal adenocarcinoma of the lower esophagus: a value-based comparison. J Surg Oncol, 2015, 112(5): 517-523.
24. Kurokawa Y, Sasako M, Sano T, et al. Ten-year follow-up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia. Br J Surg, 2015, 102(4): 341-348.
25. 馬小明, 吳建強, 王建. 食管胃結合部腺癌的研究進展. 中國普外基礎與臨床雜志, 2015, 22(5): 637-641.
26. Zheng Z, Cai J, Yin J, et al. Transthoracic versus abdominal-transhiatal resection for treating Siewert typeⅡ/Ⅲadenocarcinoma of the esophagogastric junction: a meta-analysis. Int J Clin Exp Med, 2015, 8(10): 17167-17182.
27. 黃雷, 徐阿曼, 韓文秀, 等. SiewertⅡ 型和 Ⅲ 型食管胃結合部腺癌全胃與近端胃切除術的療效比較. 中華消化外科雜志, 2014, 13(2): 110-114.
28. Takeuchi H, Kitagawa Y. Adenocarcinoma of the esophagogastric junction: territory of the esophagus or stomach, or an independent region? Ann Surg Oncol, 2013, 20(3): 705-706.
29. Masuzawa T, Takiguchi S, Hirao M, et al. Comparison of perioperative and long-term outcomes of total and proximal gastrectomy for early gastric cancer: a multi-institutional retrospective study. World J Surg, 2014, 38(5): 1100-1106.
30. Nozaki I, Hato S, Kobatake T, et al. Long-term outcome after proximal gastrectomy with jejunal interposition for gastric cancer compared with total gastrectomy. World J Surg, 2013, 37(3): 558-564.
31. 趙群, 姚繼方, 李勇, 等. SiewertⅡ、Ⅲ 型食管胃結合部腺癌兩種外科手術入路治療效果的研究. 腹部外科, 2013, 26(4): 238-240.
32. Takiguchi N, Takahashi M, Ikeda M, et al. Long-term quality-of-life comparison of total gastrectomy and proximal gastrectomy by postgastrectomy syndrome assessment scale (PGSAS-45): a nationwide multi-institutional study. Gastric Cancer, 2015, 18(2): 407-416.
33. 鄭國良, 鄭志超, 趙巖, 等. 根治性胃切除術治療 SiewertⅡ 和 Ⅲ 型食管胃結合部腺癌的療效分析. 中華腫瘤雜志, 2016, 38(7): 538-542.
34. 白順滟, 肖思潔, 吳俊超, 等. 內鏡黏膜下剝離術和黏膜切除術治療早期胃癌的臨床對比分析. 中國內鏡雜志, 2014, 20(8): 873-877.
35. Namasivayam V, Wang KK, Prasad GA. Endoscopic mucosal resection in the management of esophageal neoplasia: current status and future directions. Clin Gastroenterol Hepatol, 2010, 8(9): 743-754.
36. Ronellenfitsch U, Schwarzbach M, Hofheinz R, et al. Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus. Cochrane Database Syst Rev, 2013, 5(5): 1-88.
37. Kumagai K, Rouvelas I, Tsai JA, et al. Survival benefit and additional value of preoperative chemoradiotherapy in resectable gastric and gastro-oesophageal junction cancer: a direct and adjusted indirect comparison meta-analysis. Eur J Surg Oncol, 2015, 41(3): 282-294.
38. Shapiro J, van Lanschot JJ, Hulshof MC, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol, 2015, 16(9): 1090-1098.
39. Narita T, Seshimo A, Suzuki M, et al. Status of tissue expression and serum levels of HER2 in gastric cancer patients in Japan. Hepatogastroenterology, 2013, 60(125): 1083-1088.
40. 王士娜, 馬靜, 楊立宇, 等. HER2/neu 和 Akt2 在胃癌中的表達及意義. 中國醫科大學學報, 2013, 42(2): 131-134.
41. Soularue é, Cohen R, Tournigand C, et al. Efficacy and safety of trastuzumab in combination with oxaliplatin and fluorouracil-based chemotherapy for patients with HER2-positive metastatic gastric and gastro-oesophageal junction adenocarcinoma patients: a retrospective study. Bull Cancer, 2015, 102(4): 324-331.
42. 徐澤寬. 2015 年 V1 版《NCCN 胃癌臨床實踐指南》更新解讀. 中國實用外科雜志, 2015, (5): 512-514.
43. Okines A, Verheij M, Allum W, et al. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2010, 21 Suppl 5: v50-v54.

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Research progress of adenocarcinoma of esophago-gastric junction

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