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True esophagogastric junction adenocarcinoma: background of its definition and current surgical trends

  • Tsutomu Kumamoto
  • Yasunori Kurahashi
  • Hirotaka Niwa
  • Yasutaka Nakanishi
  • Koichi Okumura
  • Rie Ozawa
  • Yoshinori Ishida
  • Hisashi ShinoharaEmail author
Review Article
  • 84 Downloads

Abstract

The definition of true esophagogastric junction (EGJ) adenocarcinoma and its surgical treatment are debatable. We review the basis for the current definition and the Japanese surgical strategy in managing true EGJ adenocarcinoma. The Siewert classification is a well-known anatomical classification system for EGJ adenocarcinomas: type II tumors in the region 1 cm above and 2 cm below the EGJ are described as “true carcinoma of the cardia”. Coincidentally, this range matches gastric cardiac gland distribution. Conversely, Nishi’s classification is generally used to describe EGJ carcinomas, defined as tumors with the center located within 2 cm above and 2 cm below the EGJ, regardless of their histological subtype. This range coincides with the extent of the lower esophageal sphincter combined with gastric cardiac gland distribution. The current Japanese surgical strategy focuses on the tumor range from the EGJ to the esophagus and stomach. According to previous studies, the strategy can be roughly classified into three types. The optimal surgical procedure for true EGJ adenocarcinoma is controversial. However, an ongoing Japanese nationwide prospective trial will help confirm the appropriate standard surgery, including the optimal extent of lymph node dissection.

Keywords

Esophagogastric junction adenocarcinoma Gastroesophageal junction adenocarcinoma Siewert classification Surgery 

Notes

Funding

This work was supported in part by JSPS KAKENHI (Grant number 16H05399).

Compliance with ethical standards

Conflict of interest

We have no conflicts of interest to declare.

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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of SurgeryHyogo College of MedicineNishinomiyaJapan

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