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首页> 外文期刊>Surgical oncology >Cancer of the esophagogastric junction.
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Cancer of the esophagogastric junction.

机译：食管胃交界处的癌症。

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In the Western world, there has been an alarming rise in the incidence and prevalence of adenocarcinoma arising at the esophagogastric junction during recent decades. Epidemiological, clinical and pathological data support a sub-classification of adenocarcinomas arising in the vicinity of the esophagogastric junction (AEG) into adenocarcinoma of the distal esophagus (Type I), true carcinoma of the cardia (Type II) and subcardial carcinoma (Type III). While most, if not all, adenocarcinomas of the distal esophagus arise from areas with specialized intestinal metaplasia, which develop as a consequence of chronic gastroesophageal reflux, the etiology and pathogenesis of true carcinoma of the gastric cardia and subcardial gastric cancer is not clear at present. Although a subgroup of true carcinomas of the gastric cardia may also develop within short segments of intestinal metaplasia at the esophagogastric junction, a causal relation between these tumors and gastroesophageal reflux has been difficult to establish. Irrespective of the etiology, a complete removal of the primary tumor and its lymphatic drainage has to be the primary goal of any surgical approach to adenocarcinoma of the esophagogastric junction. Our experience in the management of more than 1000 such patients during the past 18 years suggests that an individualized therapeutic strategy oriented by tumor type and stage results in survival rates superior to those reported with a more indiscriminate approach. This individualized strategy prescribes a transmediastinal esophagectomy with lymphadenectomy in the lower posterior mediastinum and along the celiac axis for Type I tumors, extended total gastrectomy with transhiatal resection of the distal esophagus and D2 lymphadenectomy for Type II and Type III tumors, a limited resection of the esophagogastric junction and distal esophagus with interposition of a pedicled jejunal segment for uT1N0 tumors, and neoadjuvant chemotherapy followed by resection for uT3/T4 tumors. Extensive preoperative staging is essential to allow correct selection of the appropriate therapeutic strategy using this tailored approach.
机译：在西方世界，近几十年来在食管胃交界处出现的腺癌的发病率和流行率惊人地上升。流行病学，临床和病理学数据支持将在食管胃交界处（AEG）附近发生的腺癌细分为食管远端腺癌（I型），true门癌（II型）和cardi门下癌（III型） ）。尽管大多数（即使不是全部）食管远端腺癌起源于特殊的肠上皮化生区域，这些区域由于慢性胃食管反流而发展，但目前尚不清楚真正的胃card门癌和and门下胃癌的病因和发病机制。尽管真正的胃card门癌亚组也可能在食管胃交界处的肠上皮化生的短段内发展，但很难确定这些肿瘤与胃食管反流之间的因果关系。不论病因如何，彻底切除原发肿瘤及其淋巴引流必须是食管胃交界处腺癌的任何外科手术治疗的主要目标。在过去的18年中，我们在处理1000多名此类患者方面的经验表明，以肿瘤类型和阶段为导向的个性化治疗策略所产生的生存率要优于采用不加区分的方法所报告的生存率。这种个性化策略规定，对于I型肿瘤，在下纵隔下，沿腹腔轴行纵隔食管切除术，并沿腹腔轴行纵隔食管切除术，对食管远端食管经食管切除术，对II型和III型肿瘤进行D2淋巴结切除术，对一部分进行切除术食管胃交界处和食管远端，插入有蒂的空肠段以治疗uT1N0肿瘤，并进行新辅助化疗，然后切除uT3 / T4肿瘤。广泛的术前分期对于使用这种量身定制的方法正确选择适当的治疗策略至关重要。

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