从胸外科视角看SiewertⅡ型食管胃结合部腺癌的治疗

Treatment of Siewert type II adenocarcinoma of the esophagogastric junction:the perspectives from thoracic surgery

SiewertⅡ型食管胃结合部腺癌(AEG)相比较于SiewertⅠ、Ⅲ型,存在着较大的临床诊疗争议。《中华胃肠外科杂志》于2018年发表了首版《食管胃结合部腺癌外科治疗中国专家共识》,几年来,随着胸腔镜微创技术的发展已经证实,胸腔镜微创手术能使SiewertⅡ型AEG患者受到更小的胸部创伤,经胸行远端食管切除可以实现安全切缘,上腹-右胸入路可以保证纵隔淋巴结清扫效果并使患者生存获益。而内镜手术的发展以及综合治疗理念及其实践,也为SiewertⅡ型AEG治疗模式给予了新的补充。针对手术的残端安全问题和淋巴结清扫问题,应该开展更多的临床研究以寻求解决之道。

A greater controversy remains in clinical diagnosis and treatment of Siewert type II adenocarcinoma of esophagogastric junction(AEG),compared with Siewert type I and III AEG.In 2018,the first edition of Chinese Expert Consensus on the Surgical Treatment for Adenocarcinoma of Esophagogastric Junction was published in the Chinese Journal of Gastrointestinal Surgery.In the past few years,the advance in minimally invasive thoracoscopic surgery has been proven to reduce thoracic trauma in Siewert type II AEG.Meanwhile,distal thoracic esophagectomy can achieve more complete resection,and upper abdomen⁃right thoracic approach can ensure the mediastinal lymph node dissection and improve long⁃term survival.The concept and practice of endoscopic surgery and the comprehensive treatment also give new supplements to the treatment regimen of Siewert type II AEG.More clinical researches should be conducted to address the surgical residual safety and lymph node dissection issues.