食管胃结合部腺癌手术径路治疗策略的变迁与思考

The strategic changes and thoughts of surgical approaches for adenocarcinoma of esophagogastric junction

食管胃结合部腺癌手术径路选择引发包括肿瘤切除是否完整、切缘是否阴性、淋巴结清扫是否彻底、消化道重建是否安全以及围术期并发症发生率是否降低等问题成为近年来临床探讨与争议的热点。日本JCOG9502试验是全世界知名的关于食管胃结合部腺癌手术径路的临床试验,其对经腹或经胸手术径路给出了较为明确的循证医学证据。但由于左胸径路与右胸径路仍然存在一定差异,因此,选择合理手术径路成为东、西方学者讨论的焦点。随着微创技术的飞跃发展,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可能的治疗方式。

Surgical approaches for adenocarcinoma of esophagogastric junction have become controversial issues in recent years, including complete resection of tumors, negative proximal margin, complete lymph node dissection, safety of digestive tract reconstruction and reduction of perioperative com-plications. JCOG9502 trial in Japan is a well-known clinical trial on the surgical approach for adenocarcinoma of esophagogastric junction, which provides evidence-based medicine results for the transabdominal or transthoracic approach. However, due to the differences between the left and right thoracic approaches, the choice of a reasonable surgical approach has also become the focus of discussion between eastern and western scholars. With the development of minimally invasive surgery, it is possible to perform the operations combining laparoscopy and thoracoscopy in the future.