Therapeutic strategies for esophagogastric junction cancer

The incidence and prevalence of esophagogastric junction (EGJ) cancer have increased in Western and Asian countries in recent decades. However, previous studies on the classification, surgical treatment, and multimodal therapy in relation to these tumors have indicated multiple inconsistencies. Despite their single anatomical location and stage, studies on EGJ cancer-related therapy are scarce, because patient cases with EGJ cancer are typically examined in esophageal and gastric cancer treatment trials. Despite improvements in surgical and radiotherapy techniques and refinements to chemotherapeutic regimens, the long-term survival of patients with EGJ cancer remains poor. Surgical resection is the only standard approach for the early stage of the disease (Stage I). The primary goal of EGJ cancer operation is the complete removal of the primary tumor and its lymphatic drainage. Treatment approaches for localized, resectable EGJ cancer are based on the location of primary tumors, their histology, and patient comorbidities; however, because surgery is the fundamental approach for the treatment of Stage II-III resectable EGJ cancer, multimodality therapy with chemotherapy or chemoradiotherapy remains uncertain. This review focuses on the surgical approaches, and provides an overview of the evidence for perioperative treatment and the role of targeted therapies and ongoing clinical trials regarding EGJ cancer.