关键词: 食管胃结合部腺癌, 消化道重建, 淋巴结转移, 腹腔镜手术

Abstract: Anatomical basis and surgical approach of laparoscopic surgery for esophagogastric junction cancer        CHEN Ling, LIU Feng-lin. Department of General Surgery，Zhongshan Hospital，Fudan University，Shanghai 200032，China
Corresponding author：LIU Feng-lin，E-mail:liu.fenglin@zs-hospital.sh.cn
Abstract    The esophagogastric junction is the area between the distal esophagus and the proximal stomach, and its anti-reflux barrier consists of structures such as the lower esophageal sphincter, upper gastric sphincter, diaphragm and diaphragmatic esophageal ligament and gastroesophageal valve.After proximal gastrectomy, the incidence of reflux esophagitis in patients with simple esophageal gastric anastomosis is high, which seriously affects the quality of life.For this reason, a variety of anti-reflux procedures have emerged, and their mechanisms include rebuilding the mechanical anti-reflux barrier; forming an anti-reflux buffer zone; promoting gastric emptying; and preserving the physiologic anti-reflux barrier.Because the veins and lymphatics in the esophagogastric junction have the characteristics of cephalad and caudal bidirectional flow, when the tumor is located around the cardia and has not yet invaded the lower esophagus, it mainly metastasizes to the abdominal lymph nodes.And with the increase of the distance of the tumor invading the esophagus, the metastasis rate of the lower mediastinal lymph nodes increases significantly.Therefore, the Chinese expert consensus suggests that mediastinal lymph node dissection should be performed for Siewert type Ⅱ adenocarcinoma of esophagogastric junction if the tumor invades the esophagus more than 2 cm.The operation for Siewert type Ⅱ adenocarcinoma of esophagogastric junction can be performed by transabdominal, transthoracic, or thoracic-abdominal approaches.Transthoracic approach facilitates mediastinal lymph node dissection and lower esophageal resection, but has a high complication rate; transabdominal approach has a low complication rate, but has the disadvantage of lower mediastinal lymph node dissection and ensuring negative esophageal margins.Currently, total laparoscopic surgery for Siewert type Ⅱ adenocarcinoma of esophagogastric junction is still in the process of exploration and improvement, and the general trend is to combine transabdominal and transthoracic approaches, with the aim of bringing real survival benefits to patients.In conclusion，only through the combination of basic research on physiology and anatomy of the esophagogastric junction and clinical research, it is possible to find the optimal solution for the difficulties in the surgical treatment of esophagogastric junction cancer, so that the patients can benefit from the development of modern medical science and technology.

Key words: adenocarcinoma of esophagogastric junction, digestive tract reconstruction, lymph node metastasis, laparoscopic surgery