东西方国家对食管胃结合部腺癌外科诊断与治疗观点差异的现状和争议

Current status and controversies of the diagnosis and surgical strategies for adenocarcinoma of the esophagogastric junction between the East and the West

近年来食管胃结合部腺癌的全世界发病率呈上升趋势，外科手术是其综合诊断与治疗的重要环节。由于肿瘤部位和生物学行为的特殊性，以及流行病学特点和诊断与治疗团队的差异，在肿瘤分型分期、淋巴结清扫、手术径路、手术方式和切除范围等诸多外科问题上东西方国家的学者存在争议和认识上的差异。新的TNM分期体系对于该部位肿瘤的归属和分期虽有了新的界定，但传统的Siewert分型仍是目前决定外科手术策略的关键所在。随着微创治疗的推广和早期病变检测的提高,采用腹腔镜和胸腔镜治疗食管胃结合部腺癌将逐渐成为未来发展方向的治疗方式，而以消化道外科、肿瘤内科、影像科和麻醉科为主的多学科团队协作模式将在诊断与治疗策略的选择中起到决定作用。

The world-wide incidence of adenocareinoma of the esophagogastric junction has been on a rise in recent years. Surgical resection plays the most important role in the multimodal management for adenocarcinoma of esophagogastric junction. However, due to distinct anatomical position, biological features, epidemiology and surgical teams, many controversies and different cognitions exist among surgeons from the East and the West, including tumor staging and classification, regional lymphadenectomy, surgical approaches and extents of esophageal and gastric resection. A new TNM classification has renewed the staging system, while traditional Siewert classification still decides clinical surgical strategies. With the development of minimally invasive surgery and early detection for the lesion, it is possible to perform the operations combining laparoseopy and thoracoscopy in the future. A muhidisciplinary team from digestive surgery, oncology, radiology and anesthesiology will be essential for optimal diagnosis and management.