SiewertⅡ型食管胃结合部腺癌腔镜手术治疗中国专家共识(2023版)

Chinese expert consensus on endoscopic surgery for SiewertⅡadenocarcinoma of esophagogastric junction(2023 edition)

食管胃结合部腺癌(AEG)是位于食管下段和胃贲门交界部的腺癌,近年来其发病率呈上升趋势,受到越来越多的关注,但因其具有特殊的生物学行为特征,其定义和外科治疗原则均存在诸多争议。目前,国内外已在AEG的分型、分期、手术路径、切除范围和淋巴结清扫等外科相关领域达成一定共识,形成了一系列规范性指南。但由于SiewertⅡ型AEG解剖位置的特殊性,使其在肿瘤浸润范围、淋巴结转移途径等肿瘤生物学行为方面的复杂性,给治疗决策、手术方式和切除范围选择等带来一定难度。随着微创外科技术的发展,腹腔镜和胸腔镜等微创外科技术手段不断成熟并广泛应用于胃肠外科和胸外科恶性肿瘤的治疗,有关SiewertⅡ型AEG的微创治疗亦应得到进一步规范和推广。因此,中华医学会外科学分会腹腔镜与内镜外科学组于2019年组织专家制订了《SiewertⅡ型食管胃结合部腺癌腔镜手术治疗中国专家共识(2019版)》。近年来,随着手术技术进步,高质量临床研究相继开展,进一步推动了临床研究和循证医学证据的不断更新,SiewertⅡ型AEG的腔镜外科治疗策略也在持续优化,根据最新的临床研究证据及国际指南和共识,学组对2019版共识进行更新与修订,经专家组讨论最终形成《SiewertⅡ型食管胃结合部腺癌腔镜手术治疗中国专家共识(2023版)》,用于指导SiewertⅡ型AEG微创外科诊疗的临床实践。

Adenocarcinoma of esophagogastric junction(AEG)is the adenocarcinoma locating at the junction of the lower esophagus and gastric cardia.In recent years,the incidence of AEG has shown an upward trend and has attracted more and more attention.Because of its special biological behavior,there are still many controversies in the definition and principles of surgical treatment of AEG.At present,many consensuses have been reached on classification,staging,surgical approach,resection range,lymph node dissection and other related surgical fields of AEG,leading to a series of normative guidelines published.However,due to the particularity of the anatomical location of SiewertⅡAEG,the complexity in tumor biological behaviors such as tumor infiltration range and lymph node metastasis pathway brings certain difficulties to treatment decisions,surgical methods,and resection ranges.With the tremendous development of minimally invasive surgical techniques,laparoscopy and thoracoscopy and other minimally invasive surgical techniques have been widely used in the treatment of malignant tumors in both abdomen and thorax.The minimally invasive treatment of SiewertⅡAEG had also be further standardized and promoted.Under this circumstance,the Chinese Society of Laparoscopic and Endoscopic Surgery in Chinese Surgical Society of Chinese Medical Association organized experts to formulate the"Chinese Expert Consensus on Endoscopic Surgery for SiewertⅡAdenocarcinoma of Esophagogastric Junction(2019 Edition)".In recent years,with the advancement of surgical technology,high-quality clinical researches have been carried out constantly,which has further promoted the continuous updating of clinical research and evidence-based medecine.The endoscopic surgery for SiewertⅡAEG is also continuously optimized.Based on evidence of the latest clinical research,guidelines,and consensus,the 2019 edition of the consensus is updated and revised.After discussion and revision by the expert group,the"Chinese Expert Consensus on Endoscopic Surgery for SiewertⅡAdenocarcinoma of Esophagogastric Junction(2023 Edition)"has been finally formed,in order to guide the clinical practice of minimally invasive surgical treatment of SiewertⅡAEG.