Anatomical Understanding and Evolution of Surgical Treatment for Cancer of the Esophagogastric Junction: From Anatomical Controversies to Precision Surgery

ABSTRACT

The incidence of cancer of the esophagogastric junction (EGJC) has surged globally. Historically, its unique anatomical position and dual histological characteristics generated significant controversy regarding tumor classification and surgical strategies. However, the surgical management of EGJC has recently undergone a major paradigm shift. This review highlights these key evolutionary changes. First, the basis for surgical decision‐making has shifted from the traditional Siewert “tumor epicenter” to the objective “length of esophageal invasion.” Second, specific invasion‐length thresholds (2.0 and 4.0 cm) now precisely dictate the necessity and extent of mediastinal lymph node dissection (LND). Concurrently, routine total gastrectomy (TG) is being abandoned in favor of proximal gastrectomy (PG) with advanced antireflux reconstruction techniques. By synthesizing recent prospective data and multidisciplinary advancements, this article provides comprehensive evidence‐based support for tailoring surgical resection and lymphadenectomy to individual tumor biology, ultimately guiding precision oncology for EGJC.