Selection of surgical procedures for the patients with resectable adenocarcinoma of the esophagogastric junction        YE Ying-jiang, WANG Shan. Department of Gastroenterological Surgery, Peking University People’s Hospital, Beijing 100044, China
Corresponding author: WANG Shan, E-mail: shwang60@sina.com
Abstract    In resent years, the incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing. Surgery is the main method of treatment. However, the concept of the disease remains unclear in China, so that surgical procedures are diverse and even controversy. Adequate assessment of the classification and stage of AEG before operation, as well as following the principle of individual therapy play an important role in selecting suitable surgical procedures for the patients. For AEG I tumor, transthorasic and transhiatal resection of the distal esophagus or 3-field lymph node dissection (cervical, mediastinal, and abdominal lymph node dissection) can be performed; Total gastrectomy with transhiatal resection of the distal esophagus (transhiatally extended gastrectomy) plus abdominal and mediastinal lymphadenectomy is the best approach for AEG Ⅱ tumors. Only performing total gastrectomy can ensure a negative resection margin and enough scope of lympha node dissection. Proximal gastrectomy is acceptable by early AEG. Selecting surgical procedure for AEG Ⅲ tumor should obey the surgical principle of proximal gastric cancer. Splenectomy is not recommended in routine AEG operation. Splenectomy is only performed in patients with definited lymph node metastases or infiltration of the splenic hilum.