Current surgical treatment of esophagogastric junction adenocarcinoma

Table 1 Different classification of esophagogastric junction cancer

System	Classification	Description
Siewert classification	Type I	1-5 cm above the EGJ
	Type II	Within 1 cm above and 2 cm below the EGJ
	Type III	2-5 cm below the EGJ
AJCC/UICC TNM	Esophageal adenocarcinomas	Within 2 cm proximal or distal to the EGJ
	Gastric cancer	More than 2 cm distal from the EGJ
Japanese classification	-	A tumor (≤ 4 cm diameter) with an epicenter locating within 2 cm of the EGJ, whether adenocarcinoma or squamous cell carcinoma

EGJ: Esophagogastric junction; AJCC: American Joint Committee on Cancer; UICC: Union for International Cancer Control.

Table 2 Different approach for esophagogastric junction cancer

Approach	Surgical technique	Procedure	Disadvantage
RT	Ivor Lewis	Midline laparotomy	Limited proximal margin
			Requirement of body position change
			Surgical stress is significant
	Mckeown	Right thoracotomy	Increased risk for recurrent laryngeal nerve injury
		Midline laparotomy	Surgical stress is significant
		Left cervical
LT	LTA	Left thoracotomy extended to upper midline laparotomy	No middle or upper thoracic lymphadenectomy
			Surgical stress is significant
	Left thoracophrenolaparotomy	Transdiaphragmatic thoracotomy	No middle or upper thoracic lymphadenectomy
		Midline laparotomy	Surgical stress is significant
TH	-	Midline laparotomy	Limited proximal margin
		Left cervical	Surgical view of the lower mediastinum is poor
			No middle or upper thoracic lymphadenectomy
TG	-	Midline laparotomy	Limited proximal margin
			No thoracic lymphadenectomy

RT: Right Transthoracic; LT: Left Transthoracic; TH: transhiatal; TG: Total Gastrectomy.