An Overview of the Treatment Strategy of Esophagogastric Junction Cancer

TL;DR

This review summarizes current treatment strategies for esophagogastric junction cancer, highlighting regional differences and the need for standardized approaches.

Contribution

The paper provides a comparative analysis of Eastern and Western treatment practices and highlights recent clinical trials shaping EGJC management.

Findings

Minimally invasive approaches show safety benefits for Siewert type II tumors.

Lymph node dissection is increasingly tailored to the extent of esophageal invasion.

Immunotherapy is emerging as a promising treatment following the CheckMate 577 trial.

Abstract

The number of esophagogastric junction cancers (EGJCs) has been rising globally, yet its optimal treatment remains controversial due to its complex anatomical location. This review outlines the current evidence on surgical strategies, lymph node dissection, and perioperative therapies, with a focus on differences between Eastern and Western clinical practices. By integrating data from major global trials, this article aims to clarify regional trends and guide future standardized approaches to EGJC.

Background: The incidence of esophagogastric junction cancer (EGJC) is increasing in both Western and Eastern countries. Despite this trend, a globally accepted treatment strategy remains elusive due to the tumor’s anatomical complexity and variability in clinical practice. Aim: This review aims to provide a comprehensive overview of current evidence regarding EGJC treatment, focusing on the surgical approach, extent of lymph node dissection, and perioperative therapy. Special attention is given to regional differences and the implications of recent clinical trials. Findings: Transhiatal and minimally invasive surgical approaches have demonstrated favorable safety profiles, particularly for Siewert type II tumors. Lymph node dissection strategies are increasingly tailored based on the extent of esophageal invasion. Pre- and postoperative chemotherapy and chemoradiotherapy are standard in the West, while East Asian countries are gradually adopting these approaches through trials such as RESOLVE (China) and PRODIGY (Korea). Immunotherapy has also emerged as a promising option following the CheckMate 577 trial. Conclusions: EGJC requires individualized treatment planning based on tumor characteristics and regional practices. While ongoing trials continue to inform optimal management, international collaboration and a stepwise, biomarker-informed approach will be essential to harmonize treatment strategies for this anatomically and therapeutically complex disease.

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