| International Session (Symposium) 3 (1) (JSGS・JSGE・JSH) |
| Fri. November 2nd 9:00 - 10:30 Room 9: Portopia Hotel Main Building Kairaku 3 |
| Surgical treatment for adenocarcinoma of the esophagogastric junction | |||
| Daniela Molena | |||
| Memorial Sloan Kettering Cancer Center | |||
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| Esophagogastric junction (EGJ) tumors are recognized to have distinctive behavior than esophageal and gastric cancers; histologically, over 90% are adenocarcinoma. Prevalence of these malignancies has increased by 10% over the last 40 years.1 Many patients present with advanced disease, and consequently less than 50% undergo curative treatment.2 Observed clinicopathologic differences exist between EGJ and gastric or esophageal tumors, with EGJ tumor patients having increased incidence of lymph node and distant metastases and therefore overall worse prognosis.3,4 Nevertheless, these cancers are conventionally classified and treated as either esophageal or gastric cancers depending on the location of the tumor’s epicenter and surgeon preference.5 Preoperative chemotherapy prior to surgical resection has been demonstrated to have a survival benefit.6,7 But it remains unknown whether administering chemoradiotherapy has a survival advantage over chemotherapy alone.8 Furthermore, the optimal timing for resection following neoadjuvant therapy is also not well established. It is commonly accepted to wait 6 weeks to allow both the acute inflammation to resolve and the tumor to regress. Give that tumor regression is a slow process, and patients who achieve pCR have better survival, some argue that delay to surgery may improve patient outcomes.9 In terms of surgical approach it is important to keep in mind important principles for optimized outcomes: 1. Resection with appropriate and negative histologic margins 2. Adequate lymphadenectomy 3. Decreasing morbidity and mortality 4. Preserving quality of life In our experience whether to perform a total gastrectomy or esophagectomy is less important than observing the above principles. In the era of personalized medicine, surgeons should be able to adapt their techniques to the needs of each patient. References: 1.Okereke IC. Management of gastroesophageal junction tumors.Surg Clin N Am, 97; 2017, 265-275. 2.Barbour AP, Rizk NP, Gonen M, et al. Adenocarcinoma of the gastroesophageal junction: Influence of esophageal resection margin and operative approach on outcome.Ann Surg, 246; 2007, 1-8. 3.MacDonald WC. Clinical and pathologic features of adenocarcinoma of the gastric cardia. Cancer, 29: 1972, 724-732. 4.Saito H, Fukumoto Y, Osaki T, et al. Distinct recurrence pattern and outcome of adenocarcinoma of the gastric cardia in comparison with carcinoma of other regions of the stomach. World J Surg, 30: 2006, 1864-1869. 5.Siewert JR, Stein HJ. Adenocarcinoma of the gastroesophageal junction: classification, pathology and extent of resection. Dis Esoph 9; 1996, 173-182 6.Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med, 355: 2006, 11-20. 7.Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol, 19: 2012, 68-74. 8.Deng HY, Wang WP, Wang YC, et al. Neoadjuvant chemoradiotherapy or chemotherapy? A comprehensive systematic review and meta-analysis of the options for neoadjuvant therapy for treating oesophageal cancer. Eur J Cardiothorac Surg, 51: 2017, 421-431. 9.Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med, 345: 2001, 725-730. |
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