SiewertⅡ型食管胃结合部腺癌的手术治疗策略

Surgical treatment strategies for Siewert type II adenocarcinoma of the esophagogastric junction

食管胃结合部腺癌(AEG)发病率持续上升,其治疗模式较多,但是外科手术仍然是AEG综合治疗的基础。SiewertⅠ型和Siewert Ⅲ型分别参照食管癌和胃癌的分期系统进行治疗策略的选择,而对于Siewert Ⅱ型目前尚未达成共识。本文将对SiewertⅡ型AEG在淋巴结转移、手术入路和切除范围以及消化道重建等方面存在的诸多争议,进行简要阐述。结合当前文献以及笔者经验,建议当肿瘤浸润食管≥3 cm时,应经胸入路行彻底纵隔淋巴结清扫+全胃切除术;当肿瘤分期较早、肿瘤长径≤4 cm、且食管受累<3 cm时可经食管裂孔近端胃切除术+食管切除术。而消化道重建方式可据术者经验和患者自身条件进行选择。

The incidence of adenocarcinoma of the esophagogastric junction(AEG)continues to rise.While many treatment modalities are available,surgery is still the basis of comprehensive treatment of AEG.Siewert type II AEG,is more controversial than the other two types in terms of lymph node metastasis,surgical approach,extent of resection,and digestive tract reconstruction.When the distance of the superior tumor margin is more than 3 cm proximal to the EGJ line is more than 3 cm,thorough mediastinal lymph node dissection should be performed through thoracic approach.Total gastrectomy is the treatment of choice for Siewert type II tumors.When the tumor stage is in an early stage,the length of the tumor is≤4 cm,and esophageal involvement is less than 3 cm,transthoracic esophagectomy plus proximal gastrectomy is feasible.The digestive tract reconstruction can be based on the experience of the operator and patient's choice of conditions.