Surgical Management of Esophagogastric Junction Cancer - Retrospective Study

Abstract Esophagogastric junction cancer is a boundary oncological pathology characterized by tumors located at the interface between the esophagus and stomach, with proximal and distal limits established according to the Siewert classification, which describes three types (I, II, and III) depending on the position of the tumor center relative to the esophagogastric junction. The surgical approach is determined both by this classification and by the surgeon’s experience and the level of expertise of the center where the procedure is performed. Radical surgery is based on preoperative TNM staging. The types of surgery performed and agreed upon by most centers are: transthoracic esophagectomy (Ivor Lewis), transhiatal esophagectomy (Orrienger), abdominal esophagogastrectomy (Hill), McKeown esophagectomy (triple approach), and total gastrectomy. Restoring digestive continuity usually involves the use of the stomach and jejunum, but when the situation requires it, the colon can also be used. As for lymph node dissection, it is performed either by dissection or by en bloc excision, both approaches being accepted. For the most accurate postoperative staging, at least 15 lymph nodes must be harvested. Splenectomy has a limited indication and is justified only when imaging or intraoperative findings reveal invasion of lymph nodes located along the splenic artery or at the splenic hilum. Neoadjuvant chemoradiotherapy is indicated for patients with locally advanced esophagogastric junction adenocarcinoma (Siewert type I-III), with the aim of reducing tumor volume and increasing the probability of achieving complete resection (R0). In situations where radical surgery is not possible, treatment options include endoscopic esophageal stenting, feeding gastrostomy (PEG or classic), and palliative chemotherapy. In conclusion, the surgical management of esophagogastric junction cancer is complex, guided by the Siewert classification and preoperative staging according to the TNM system -fundamental landmarks in establishing the therapeutic approach.