Ⅱ、Ⅲ型食管胃结合部腺癌外科治疗的研究进展

Progress of operative treatment for adenocarcinoma of the esophagogastric junction

食管胃结合部腺癌(AEG)近年来在东西方国家发病率均明显增加,其发生与胃食管反流性疾病(GERD)等多种因素有关。以手术为基础的综合治疗是进展期AEG的有效治疗手段,但SiewertⅡ/Ⅲ型AEG切除范围、淋巴清扫及微创技术应用尚存在争议。局限于黏膜内的早期AEG可以行内镜下治疗,腹腔镜技术在早期远端胃癌中安全有效,但腹腔镜及机器人手术系统等微创技术应用于进展期AEG其安全性及长期预后尚缺乏足够的循证医学证据。多数研究认为对于Ⅱ/Ⅲ型AEG,手术方式和入路并不影响患者长期预后,而TNM分期、辅助及新辅助治疗以及多学科综合治疗等是影响长期预后的重要因素。

The incidence of adenocarcinoma of the esophagogastric junction（AEG） is rapidly growing in recent years. Gastroesophageal reflux disease（GERD） and some relative factors associated with GRED promote and even result in the genesis of AEG. Presently multiple comprehensive treatment based on surgery for advanced stage diseases is supposed to be an effective method. While, it is still controversial about surgery of AEG, especially in Siewert typeⅡ.endoscopical therapy can be the treatment for patients with high-grade intraepithelial neoplasia and mucosal AEG, and laparoscopic gastrectomy is effective and safe for the treatment of early esophagogastric junction（EGJ） cancer. However, minimally invasive techniques such as laparoscopic gastrectomy and robotic surgery systems for advanced AEG are still lack of evidence-based medicine evidences for safety and long-term prognosis. At present, most studies indicated that, for type Ⅱ/Ⅲ type AEG, it is not operative approach or extent of resection but factors such as clinical and pathological tumor, nodes, metastasis（TNM） stages, adjuvant chemotherapy, neoadjuvant therapy and multidisciplinary treatment that have an influence on the long-term outcome.