食道胃接合部腺癌の分類と外科治療

• Published in: 日大医学雑誌 Vol. 81; no. 5; pp. 247 - 253
• Main Author: 山下, 裕玄
• Format: Journal Article
• Language: Japanese
• Published: 日本大学医学会 01.10.2022
• Subjects: Siewert 分類; 噴門側胃切除; 西分類; 食道亜全摘; 食道胃接合部
• ISSN: 0029-0424; 1884-0779
• DOI: 10.4264/numa.81.5_247

Despite substantial declines in gastric cancer incidence, the incidence of adenocarcinoma of the esophagogastricjunction (AEG) has been rising remarkably worldwide and is drawing considerable attention as well as concern.However, the optimal extent of esophagogastric resection for this tumor entity, especially Siewert type II tumorslocated at the true cardia, remains highly controversial. Given the uncertainty about the optimal extent of prophylactic lymph node dissection, both subtotal esophagectomy and extended total gastrectomy have been advocatedfor this tumor entity. A recent Japanese questionnaire-based national retrospective study showed that completenodal clearance along the distal portion of the stomach offered marginal survival benefits for patients with AEGless than 4 cm in diameter. A prospective nationwide multicenter study accurately identified the distribution oflymph node metastases from advanced AEG, suggesting that it is not recommended to completely dissect lymphnode stations along the distal portion of the stomach. Total gastrectomy might be employed less frequently andconsequently replaced by subtotal esophagectomy or extended proximal gastrectomy in clinical practice.