Surgical treatment in esophagogastric cancer. Trends and recent advances

The incidence of gastric cancer has been steadily declining during the last decade in the Western world. In contrast, the incidence of the adenocarcinoma of the esophagogastric junction (AEG) has been continually rising. Gastric cancer continues to be a leading cause of cancer death and has a poor prognosis despite subsequent 5-year survival improvement of 10 % during the last two decades. Literature research and analysis of clinical trials. Adenocarcinoma of the esophagogastric junction have a different tumor biology and prognosis; hence, adenocarcinoma of the esophagogastric junction represents a separate tumor entity. Topographic-anatomical classification differentiates three subtypes (AEG I-III). Radical resection is the only option to cure the disease. In gastric cancer, the histological subtype (intestinal vs. diffuse) defines the extent of the resection (subtotal vs. total), whereas in AEG, topographical classification determines the resection dimensions (extended gastrectomy vs. esophagectomy). In gastric cancer, a D2 lymphadenctomy (compartments I and II) is the gold standard. In AEG type I, a 2-field lymphadenctomy and in AEG types II and III a D2 lymphadenctomy including dissection of the lower mediastinal lymph nodes is performed. Surgical standards are available and should be followed for gastric cancer and AEG I and III tumors. The optimal surgical approach for AEG type II tumors remains at current open. Multimodal therapy concepts can increase R0-resection rates and improve prognosis in locally advanced disease. In the palliative situation, surgery in the context of multimodal therapy can contribute to improvement of quality of life and increased survival.