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Proposal for T3 classification of esophagogastric junction carcinoma based on the interconnection of extramural anatomical structures

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Abstract

Classification of extramural invasion of esophagogastric junction carcinoma (EGJC) is not yet established. The anatomy surrounding the EGJ alters between the mediastinum and the abdominal cavity. This review proposed a T3 classification of EGJC based on anatomical continuity. Analysis of endoscopic ultrasound images, review of intraoperative images, and detailed observation of surgical specimens were followed by a review of the literature. In the EGJ, the muscularis propria of the esophagus is enclosed in mediastinal adipose tissue called the adventitia, which is surrounded by the diaphragmatic crus and contains the paraesophageal lymph nodes (LNs). After passing through the esophageal hiatus along with the vagus nerves and blood vessels, the adventitia joins the adipose tissue containing the paracardial LNs, which is covered by the peritoneum, and then further divides into the lesser and greater omentum. The connective tissue outside the muscularis propria of the stomach, including the adipose tissue of the omentum, is called the subserosa. According to the TNM classification, T3 esophageal and gastric cancer is defined as invasion of the adventitia and subserosa, respectively. Given that the adventitia is anatomically continuous with the subserosa, T3 tumors of the EGJ can be described as those that extend through the muscularis propria but do not invade the peritoneum or diaphragmatic crus. We propose classifying T3 EGJC as “tumor extends through muscularis propria” rather than using the separate terms “adventitia” and “submucosa”. T4 could be “tumor perforates serosa or invades adjacent structures”, as per the current gastric cancer classification.

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Acknowledgements

This work was supported in part by Japan Society for the Promotion of Science KAKENHI Grant Numbers 22H03153 (HS) and 21K08809 (YK).

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan

    Yasunori Kurahashi, Tatsuro Nakamura, Eiichiro Nakao, Yudai Hojo, Shugo Kohno, Yoshinori Ishida & Hisashi Shinohara

  2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan

    Toshihiko Tomita

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  1. Yasunori Kurahashi
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Correspondence to Hisashi Shinohara.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

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Kurahashi, Y., Tomita, T., Nakamura, T. et al. Proposal for T3 classification of esophagogastric junction carcinoma based on the interconnection of extramural anatomical structures. Esophagus 20, 587–594 (2023). https://doi.org/10.1007/s10388-023-01023-x

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