食管胃结合部癌分型的思考与争议:基于食管浸润长度的改良分型

Controversies on the classification of esophagogastric junction carcinoma‒a modified classi-fication based on esophageal invasion length

食管胃结合部癌由于肿瘤部位的特殊性,外科手术需同时满足肿瘤切缘阴性、淋巴结清扫及消化道重建安全性,因此日益受到食管胃外科医师的关注和重视。目前Siewert及Nishi分型以肿瘤中心为分型依据,难以在术前、术中对肿瘤中心进行直观、精准地评估与定位。因此,上述分型对食管胃结合部癌的手术方式、径路选择及淋巴结清扫范围的实际指导作用受限。笔者系统分析Siewert及Nishi分型的局限性,探讨食管浸润长度与纵隔淋巴结转移的关系及在手术径路选择中的作用,并据此提出以食管浸润长度为核心改良分型的设想:(1)肿瘤上缘或下缘累及食管胃结合部(EGJ)区的恶性肿瘤均认为是食管胃结合部癌。(2)肿瘤上缘位于EGJ上>3.0 cm为Ⅰ型。(3)肿瘤上缘位于EGJ上0~3.0 cm为Ⅱ型。(4)肿瘤上缘位于EGJ下0~2.0 cm为Ⅲ型。

Due to the particularity of tumor location,the surgery of esophagogastric junc-tion(EGJ)carcinoma needs to meet the safety of negative tumor margin,lymph node dissection and digestive tract reconstruction at the same time,which attracted more and more attention of esopha-gogastric surgeons.The current Siewert and Nishi classifications are based on the tumor epicenter,which is difficult to be accurately evaluated and measured before and during operation,and also lack of significance in determining the surgical methods and approach and lymph node dissection.The authors systematically analyze the limitations of Siewert and Nishi classification,discuss the relationship between esophageal invasion length and mediastinal lymph node metastasis and the role of esophageal invasion length on selection of surgical approach,and propose a modified classi-fication based on esophageal invasion length,including(1)malignant tumors with the upper or lower edge of tumor involving the zone of EGJ are defined as EGJ carcinoma;(2)EGJ carcinoma with the upper edge of tumor located 3.0 cm above the EGJ is classified as typeⅠ;(3)EGJ carcinoma with the upper edge of tumor located 0‒3.0 cm above the EGJ is classified as typeⅡ;(4)EGJ carcinoma with the upper edge of tumor located 0‒2.0 cm below the EGJ is classified as type Ⅲ.