| International Session (Symposium) 3 (1) (JSGS・JSGE・JSH) |
| Fri. November 2nd 9:00 - 10:30 Room 9: Portopia Hotel Main Building Kairaku 3 |
| Optimal extent of surgical resection for adenocarcinoma of the esophagogastric junction | |||
| Hiroharu Yamashita1, Yasuyuki Seto1 | |||
| 1Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo | |||
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| Adenocarcinoma of the esophagogastric junction (AEG) basically involves the anatomical border between the esophagus and the stomach, and is generally classified into 3 subtypes based on the topography of the tumor epicenter; type I, 1?5 cm above the EGJ; type II, 1 cm above to 2 cm below the EGJ; type III, 2?5 cm below the EGJ. Tumor burden is essentially esophageal in type I and gastric in type III, and in general the former is thus treated by subtotal esophagectomy as an esophageal carcinoma and the latter by extended total gastrectomy as a gastric carcinoma. Debate persists as to whether surgical procedure for type II AEG is subtotal esophagectomy or extended total gastrectomy since it basically distributed at the borderline between the two organs. Many retrospective studies including Japanese nationwide retrospective tudy showed very low incidence of lymph node metastasis along with the distal portion of the stomach. Furthermore, therapeutic values of their dissection are reported to be very low as well. Total gastrectomy in an aim to complete prophylactic perigastric lymphadenectomy appears to be oncologically not essential for most of the type II AEGs. In light of the conclusion of landmark trial JCOG9502, transhiatal procedure without thoracotomy is the standard approach for AEGs whose oral edge are within 3cm from the esophagogastric junction. Taken together, extended proximal gastrectomy appears to be a minimal requirement for type II AEG, and extent of esophageal and/or gastric resection would be tailored according to the tumor extension to each organ. |
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Index Term 1: adenocarcinoma of esophagogastric junction Index Term 2: proximal gastrectomy |
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