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Hépato-Gastro & Oncologie Digestive

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Carcinoma of the oesophago-gastric junction: which curative therapeutic strategy? Volume 17, issue 6, novembre-décembre 2010

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Authors
Service de chirurgie digestive et générale, Centre hospitalier régional et universitaire Claude-Huriez, Place de Verdun, 59037 Lille Cedex, France

Whereas prevalence of distal stomach cancer is decreasing in the western world, there has been an alarming rise in the incidence of junctional adenocarcinoma (OGJA) during recent decades. Recent reports show that prognosis of OGJA remains poor. Due to their anatomical location between oesophagus and stomach, therapeutic strategy is questionable, reason for this short review. Surgery is the standard treatment based on Siewert's classification associated with a regional lymphadenectomy. Transthoracic oesophagectomy is recommended for OGJA type I, total gastrectomy is recommended for type III OGJA and both approaches could be considered for OGJA type II. Surgery alone is the recommended treatment only for stage I tumours. Perioperative chemotherapy should be considered for stage II, III and non metastatic stage IV tumours. Adjuvant chemoradiation should be proposed for tumours with high-risk of recurrence in absence of neoadjuvant therapy. In the neoadjuvant setting, neoadjuvant chemoradiation could be proposed for prominently oesophageal OGJA, but would probably become a standard treatment for all OGJA tumours in the next future. Multidisciplinary approach is essential for optimal diagnosis and therapeutic strategy.