食管胃结合部癌定义与分型的再认识

Reunderstanding of the definition and classification of esophagogastric junction cancer

近年来,对食管胃结合部腺癌(AEG)的诊断与治疗越来越引起临床重视。目前有德国学者Siewert提出的AEG定义和分型,以及日本学者Nishi提出的食管胃结合部癌的定义和分型,我国学者采用的是前者定义和分型。笔者分析Siewert与Nishi定义及分型的不同和存在的问题,并结合我国食管胃结合部组织病理学(食管下段以鳞癌占绝大多数而腺癌极少)完全不同于欧美等西方国家的特点,提出改良分型,将跨越食管胃结合部上下3 cm内的恶性肿瘤定义为食管胃结合部癌(包括鳞癌、腺癌等),肿瘤中心在食管胃结合部上者为Ⅰ型;下者为Ⅱ型;位于食管胃结合部者如鳞癌为Ⅰ型,腺癌为Ⅱ型。根据此定义和分型,笔者讨论手术路径、食管和胃切除范围、淋巴结清扫范围以及肿瘤分期等问题。

In recent years,the diagnosis and treatment of adenocarcinoma of esophagogastric junction(AEG)has attracted more and more clinical attention.At present,there are two kinds of definitions and classifications.One is about AEG,proposed by the Siewert from Germany,the other is about esophagogastric junction cancer,proposed by the Nishi from Japan,and the former is adopted in China.The authors analyze the differences and shortcomings in definition and classification between the Siewert and the Nishi,and propose a modified classification based on the histopathology of the esophagogastric junction in China(squamous cell carcinoma accounts for the majority in the lower esophageal segment and adenocarcinoma is rare),which is completely different from Western countries such as Europe and America.In this modified classification,malignant tumors within 3 cm above and below the esophagogastric junction are defined as esophagogastric junction cancer(including squamous cell carcinoma,adenocarcinoma,etc.),and tumor center above or below esophagogastric junction are defined as typeⅠand typeⅡ.If the tumor center is located at esophagogastric junction,squamous cell carcinoma is defined as type I,and adenocarcinoma is defined as typeⅡ.According to this definition and classification,the authors discuss the surgical approach,the extent of esophagectomy and gastrectomy,the extent of lymphadenectomy,and the tumor staging.