Individualized surgical strategies for cancer of the esophagogastric junction.

Annales chirurgiae et gynaecologiae Pub Date : 2000-01-01
H J Stein, M Feith, J R Siewert
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Abstract

Due to their borderline location between the stomach and esophagus the optimal surgical strategy for patients with adenocarcinoma of the esophagogastric junction is controversial. Irrespective of the surgical approach a complete removal of the primary tumor and its lymphatic drainage has to be the primary goal of surgical treatment of such tumors. Based on the experience with surgical resection of more than 1000 patients with adenocarcinoma of the esophagogastric junction we recommend an individualized surgical strategy guided by tumor stage and topographic location of the tumor center or tumor mass. This requires detailed preoperative staging and classification of tumors arising in the vicinity of the esophagogastric junction into adenocarcinoma of the distal esophagus (AEG Type I Tumors), true carcinoma of the gastric cardia (AEG Type II Tumors) and subcardial gastric carcinoma infiltrating the esophagogastric junction (AEG Type III Tumors). In patients with Type I Tumors transthoracic esophagectomy offers no survival benefit over radical transmediastinal esophagectomy, but is associated with higher morbidity. In patients with Type II or Type III tumors an extended total gastrectomy results in equal or superior survival and less postoperative mortality than a more extended esophagogastrectomy. In patients with early tumors, staged as uT1 on preoperative endosonography, a limited resection of the proximal stomach, cardia and distal esophagus with interposition of a pedicled isoperistaltic jejunal segment allows a complete tumor removal with adequate lymphadenectomy and offers excellent functional results. Multimodal treatment protocols with neoadjuvant chemotherapy or combined radiochemotherapy followed by surgical resection appear to markedly improve the prognosis in patients with locally advanced tumors who respond to preoperative treatment. With this tailored approach extensive preoperative staging becomes mandatory for an adequate selection of the appropriate therapeutic concept.

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食管胃交界处癌的个体化手术策略。
由于其介于胃和食管之间的交界位置,食管胃交界处腺癌患者的最佳手术策略存在争议。无论采用何种手术方式,完全切除原发肿瘤及其淋巴引流是此类肿瘤手术治疗的首要目标。根据1000多例食管胃交界处腺癌手术切除的经验,我们推荐根据肿瘤分期和肿瘤中心或肿瘤肿块的地理位置指导的个体化手术策略。这就需要对发生在食管胃交界处附近的肿瘤进行详细的术前分期和分类,包括食管远端腺癌(AEG I型肿瘤)、真贲门癌(AEG II型肿瘤)和浸润食管胃交界处的心下胃癌(AEG III型肿瘤)。在I型肿瘤患者中,经胸食管切除术与根治性经纵隔食管切除术相比没有生存优势,但与更高的发病率相关。对于II型或III型肿瘤患者,延长全胃切除术的生存率与延长食管胃切除术相同或更高,术后死亡率更低。对于术前超声诊断为uT1期的早期肿瘤患者,行胃近端、贲门和食管远端有限切除,间或行带蒂等肠段空肠,可完全切除肿瘤并充分切除淋巴结,功能效果良好。新辅助化疗或放化疗联合手术切除的多模式治疗方案似乎显著改善了对术前治疗有反应的局部晚期肿瘤患者的预后。有了这种量身定制的方法,广泛的术前分期成为必要的,以充分选择适当的治疗概念。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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