Carcinomas involving the esophagogastric junction (EGJ-Ca). A reevaluation of the criteria.
The present study aims to elucidate more clearly the definition and criteria for carcinomas involving the esophagogastric junction (EGJ-Ca) from a practical viewpoint based on the concept that an EGJ-Ca is a separate surgical disease entity different from either a lower-esophageal or an upper-gastric carcinoma. Among a series of 397 cases of upper-gastric carcinoma and EGJ-Ca resected during a 31-year period between 1963 and 1993, 79 patients with EGJ-Ca (EGJ-Index ranging between 250 and 750) were selected according to lesions with the central point confined within the EGJ-zone 20 mm each proximal and distal to the EGJ-line. Selected for the control group were 97 patients with upper-gastric carcinoma that was strictly confined within the upper third segment of the stomach without involving the EGJ-line upward or the middle third segment downward and with the central point of lesions outside the EGJ-zone. The comparative analysis indicated that an EGJ-Ca might be well defined not only by the EGJ-Index, but also by the EGJ-zone and the localization of the central points of lesions confined within the EGJ-zone. The definition and criteria for EGJ-Ca were thus modified from those of the previous proposal and proposed in this study with three main factors: (1) the EGJ-Index, (2) the EGJ-zone, and (3) the localization of the central point of lesions.