The Multidisciplinary Approach and Surgical Management of GE Junction Adenocarcinoma

Simple Summary The management of adenocarcinomas of the gastroesophageal junction is rapidly evolving, making it an interesting and important subject for review. In this review article, we provide a brief overview of the anatomic considerations that impact management and discuss the questions of true biologic nature, incidence, and prognosis that still persist. We discuss the choice of non-operative modalities-chemotherapy, chemoradiation, and immunotherapy-and describe key results from major trials that guide the current standard of care for treatment. We describe in more detail the surgical techniques for esophagectomy, including the advantages and disadvantages of each method, as well as newer surgical techniques for proximal gastrectomy that are especially applicable to Siewert type II tumors.Abstract Gastroesophageal (GE) junction adenocarcinoma is an aggressive malignancy of growing incidence and is associated with public health issues such as obesity and GERD. Management has evolved over the last two decades to incorporate a multidisciplinary approach, including endoscopic intervention, neoadjuvant chemotherapy/chemoradiation, and minimally invasive or more limited surgical approaches. Surgical approaches include esophagectomy, total gastrectomy, and, more recently, proximal gastrectomy. This review analyzes the evidence for and applicability of these varied approaches in management, as well as areas of continued controversy and investigation.