摘要
第91届日本胃癌协会年会于2019年2月26日至3月1日在日本静冈召开。笔者整理和剖析了本次会议中食管胃结合部(EGJ)癌流行病学、诊断及最新治疗策略的研究进展。流行病学数据显示过去30年EGJ鳞癌的发病率呈逐渐下降趋势,而食管胃结合部腺癌(AEG)呈逐渐上升趋势。由于特殊的解剖位置,早期EGJ癌行内镜黏膜下剥离术的适应证要求严格。多项研究结果已证实EGJ癌的围术期治疗在欧洲国家已成为标准治疗。亦有多项研究探讨施行新辅助放化疗的客观疗效。由日本胃癌学会和食管癌学会共同发起的多中心、随机化、前瞻性临床研究回答了AEG手术径路和淋巴结清扫范围的争议问题。近端胃切除术后合理消化道重建具有挑战性,近端胃管间置具有一定合理性,而空肠间置和双通路应选择经腹手术径路。双浆肌层瓣法消化道重建可实现重建食管下端括约肌的效果,但应严格掌握手术适应证。
The 91st Annual Meeting of Japanese Gastric Cancer Association was held in Shizuoka, Japan from 26th February to 1st March, 2019. In this article, the author reviewed the analyzed research progress of the esophagogastric junction EGJ cancer in this meeting. Epidemiological data show that in the past 30 years, the incidence of squamous cell carcinoma of the EGJ is gradually decreasing, and the incidence of adenocarcinoma of the esophagogastric junction (AEG) is gradually increasing. Due to the special anatomical position, endoscopic surgery for early EGJ cancer is more demanding. Perioperative therapy is the standard treatment in Europe, which is confirmed by many researches.There were many researches aimed to investigate objective efficacy of neoadjuvant chemoradiotherapy. A multicenter prospective randomized study co-sponsored by the Japanese Society of Gastric Cancer and Society of Esophageal Cancer has answered the controversial clinical question of surgical approach and extent of lymph node dissection for AEG. Reasonable reconstruction of digestive tract after proximal gastrectomy is challenging. The proximal gastric tube interposition has clinical rationality, and the transhiatal approach should be chosen for jejunal interposition and double tract reconstruction. The reconstruction of lower esophageal sphincter was achieved by Kamikawa method, however, its indication should be strictly controlled.
作者
梁寒
Liang Han(Department of Gastrointestinal Oncological Surgery, Cancer Hospital, Tianjin Medical University Camcer Institute & Hospital/ National Clinical Research Center for Cancer/ Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2019年第6期532-535,共4页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金(81572372)
国家重点研发项目(2016YFC1303202,2017YFC0908304).
关键词
食管胃结合部癌
内镜下黏膜剥离术
手术径路
淋巴结清扫
消化道重建
Esophagogastric junction cancer
Endoscopic submucosal dissection
Surgical approach
Lymphadenectomy
Reconstruction
