Surgical management of esophagogastric junction tumors

Abstract

Surgical resection with lymphadenectomy is the mainstay of treatment for all resectable esophagogastric junction tumors, prior to systemic generalization of the disease. This makes accurate pre-treatment staging and classification of the tumors most demanding. A well-established and internationally accepted classification for adenocarcinomas of the esophagogastric junction (AEG) helps to choose the appropriate surgical approach and to make results from different institutions comparable. Distal esophageal adenocarcinomas (AEG I) are distinguished from true cardia carcinomas (AEG II) and subcardiac gastric cancers (AEG III). Substantial advancements in this surgical field during the preceding decades have clearly revealed that individualization of the surgical strategy is the key to successfully approaching these entities. In this review we discuss the surgical management of esophagogastric junction tumors with a tailored surgical strategy.

Figure 1

Overall 10-year survival rate of patients with resected adenocarcinoma of the esophagogastric junction. Patients with complete macroscopic and microscopic tumor resection (R0 resection) versus patients with resection (R1/R2 resection) (Date of the Chirurgische Klinik und Poliklinik, Klinikum rechts der lsar der TU Munchen 1982-1999).

Figure 2

Ten-year survival rate of patients with R0-resected true carcinoma of the gastric cardia (AEG Type-II). Radical transmediastinal esophagectomy versus extend total gastrectomy (Date of the Chirurgische Klinik und Poliklinik, Klinikum rechts der lsar der TU Munchen 1982-1999).