Classification, diagnosis and surgical treatment of carcinomas of the gastroesophageal junction.

The incidence of adenocarcinoma of the gastroesophageal junction has risen faster than that of any other malignancy in various western countries. Adenocarcinoma of the gastroesophageal junction can be topographically classified into three types: carcinomas of the distal esophagus (type I), true carcinomas of the cardia (type II) and carcinomas of the subcardial region (type III). This surgical classification has proven to be of value for planning the extent of resection and for comparing epidemiologic data and therapeutic results of different series. The preoperative assignment is achieved by contrast X-ray and endoscopy and enables the surgeon to plan preoperatively the adequate extent of the resection. The type I-adenocarcinoma represents a distal esophageal cancer and consequently is treated by esophageal resection as transhiatal subtotal radical esophagectomy or in case of more proximal carcinoma by transthoracic en bloc esophagectomy. The type II- and type III-adenocarcinomas are treated by a gastrectomy and distal esophageal resection with D2-lymphadenectomy via an abdominal and transhiatal approach. In case of an advanced carcinoma with high risk of incomplete resection, neoadjuvant radiochemotherapy should be taken into consideration.