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Gastrointestinal Cancer

Management of Gastroesophageal Tumors

Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

Key Words. Esophageal carcinoma • Gastric carcinoma • Esophagogastrectomy • Neoadjuvant therapy • Adjuvant therapy

Correspondence: David W. Rattner, M.D., Division of General and Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman Street, Boston, Massachusetts 02114, USA. Telephone: 617-726-1893; Fax: 617-724-0355; e-mail: drattner{at}partners.org

The incidence of adenocarcinomas of the gastroesophageal junction has increased in recent years. These tumors possess distinct pathophysiologic characteristics. Although the consensus is that an R₀ resection (complete microscopic and macroscopic resection) is the goal when operating for curative intent, much controversy remains regarding other aspects of patient management. There is lack of consensus regarding the type of surgery to perform, the role and extent of lymphadenectomy, and the role of neoadjuvant therapy. Utilizing an evidence-based approach, this review article provides an overview of the management of gastroesophageal junction carcinomas with particular emphasis on current areas of controversy.