重视食管胃结合部腺癌的规范综合治疗

Attention to the standardized combined therapy of adenocarcinoma of the esophagogastric junction

食管胃结合部腺癌(AEG)的发病率呈持续上升趋势,尤其是在西方国家,增长速度远远高于东方国家。对于SiewertI型AEG,其生物学特性和外科治疗方案更接近于食管癌;对于SiewertⅡ、Ⅲ型AEG,外科治疗方案更接近于胃癌。目前有两个大型的Ⅲ期临床试验比较了不同术式的效果:SiewertI型AEG建议采用经胸切除的手术;而SiewertⅡ、Ⅲ型肿瘤建议采用开腹经食管裂孔的术式。同时,围手术期化疗、化放疗的作用也在临床试验中得到了进一步证实。

The incidence of adenocarcinoma of the esophagogastric junction （AEG） is dramatically increasing in Western countries, while it is not increasing in Eastern countries. Two surgical phase III trials have indicated that AEG type I should be treated surgically as esophageal cancer, and right thoracic approach with a mediastinal lymph node dissection may be recommended.While types II and III should be regarded as true gastric cancer, and a transhiatal extended gastrectomy is the preferable approach for type II and type III tumors. Meanwhile, perioperative chemotherapy and chemoradiotherapy have been approved in the clinical trials recently.