CAJ | 학술논문

本文对食管胃交界部腺癌的以手术为主的综合治疗的进展进行了全面的复习和总结.Siewert分型对于食管胃交界区域腺癌的手术入路选择比较实用.对于Siewert Ⅰ型(实际为食管胸下段癌),目前国内外观点趋于一致,应按食管癌TNM分期标准,首选Ivor-Lewis手术,行扩大二野淋巴结清扫.对于SiewertⅡ型(实际为贲门癌)应选择经左后外切口开胸开膈行食管胃部分切除,但当患者年龄偏大或身体条件差时,可以考虑选择经腹和扩大食管裂孔行食管胃部分切除.SiewertⅢ型(胃癌),可以考虑选择经腹和扩大食管裂孔或左后外切口开胸开膈行食管胃部分切除,尤其考虑胸腔有可疑淋巴结转移或肿瘤累及EGJ以上食管可能导致上切缘阳性时,要考虑选择左后外切口开胸开膈行食管胃部分切除.围手术期化疗或术前同步放化疗对提高手术切除率或生存率有益,因此,对于肿瘤较大或有明显淋巴结转移的患者可以考虑术前化疗或同步放化疗以提高R0手术切除率和长期生存,但术前同步放化疗会增加手术并发症风险.术后辅助治疗首选同步放化疗.
본문대식관위교계부선암적이수술위주적종합치료적진전진행료전면적복습화총결.Siewert분형대우식관위교계구역선암적수술입로선택비교실용.대우Siewert Ⅰ형(실제위식관흉하단암),목전국내외관점추우일치,응안식관암TNM분기표준,수선Ivor-Lewis수술,행확대이야림파결청소.대우SiewertⅡ형(실제위분문암)응선택경좌후외절구개흉개격행식관위부분절제,단당환자년령편대혹신체조건차시,가이고필선택경복화확대식관렬공행식관위부분절제.SiewertⅢ형(위암),가이고필선택경복화확대식관렬공혹좌후외절구개흉개격행식관위부분절제,우기고필흉강유가의림파결전이혹종류루급EGJ이상식관가능도치상절연양성시,요고필선택좌후외절구개흉개격행식관위부분절제.위수술기화료혹술전동보방화료대제고수술절제솔혹생존솔유익,인차,대우종류교대혹유명현림파결전이적환자가이고필술전화료혹동보방화료이제고R0수술절제솔화장기생존,단술전동보방화료회증가수술병발증풍험.술후보조치료수선동보방화료.
The definition of esophagogastric junction (EGJ) adenocarcinoma and progress in multidisciplinary treatment for the tumor were revised in this review.Siewert classification is especially useful for the surgical approach of EGJ adenocarcinoma.Siewert Ⅰ shoule be treated as esophageal cancer,and Ivor-Lewis esophagogastrectomy (right thoracotomy and laparotomy) is recommended as an extended two-field lymphadenectomy.For Siewert Ⅱ or Ⅲ tumors,left thoracophrenolaparotomy is preferred,especially in case of positive thoracic lymph nodes or positive resection margin.If there is any contraindication against thoracotomy,or a high operating risk,a transhiatal esophagectomy with lower mediastinal lymphadenectomy is an alternative.Preoperative chemoradiotherapy or perioperative chemotherapy improves overall survival and the rate of complete resection for patients with large tumor or lymph node metastasis.Neoadjuvant chemoradiotherapy is associated with high but acceptable postoperative complications.Adjuvant chemoradiotherapy remains a rational standard therapy for curatively resected EGJ cancer with T3 or greater lesion or positive nodes.