Surveys on diagnosis and treatment of esophagogastric junction adenocarcinoma by the Chinese Laparoscopic Gastrointestinal Surgery Study Group-10 Research Team

Abstract

Objective: To investigate the diagnosis and treatment of esophagogastric junction (AEG) adenocarcinoma by members of the Chinese Laparoscopic Gastrointestinal Surgery Study Group (CLASS)-10 research team. Methods: A questionnaire was distributed to the CLASS-10 study group, which consists of investigators and research assistants from 32 centers in China, all of whom are gastric surgeons. The questionnaire was administered before the start of the study (2020) and mid-study (2022). The survey was developed to address the participants'perceptions of surgical consultation and management of AEG and included three main areas: diagnosis, surgical treatment, and perioperative management. In the second survey, the first two sections of the initial questionnaire were supplemented: the diagnosis section with a survey on the respondent's title, type of hospital, and definition of AEG, and the surgical treatment section with a survey on the perception of inferior mediastinal lymph node dissection as addressed in the CLASS-10 study. Respondents' clinical perceptions of AEG were recorded and the differences in perceptions between the two surveys analyzed. Results: Thirty-two and 34 questionnaires were returned in the first and second surveys, respectively. Regarding the definition of AEG adenocarcinoma, the highest acceptance rate was for the Chinese expert consensus (18/34, 52.9%), in which they are defined as lesions whose epicenter is located within 5 cm proximal or distal to the esophagogastric junction (EGJ) and crossing or touching the EGJ. Regarding the anatomic landmark for the EGJ, the percentage of respondents choosing the dentate line increased from 68.8% (22/32) to 88.2% (30/34) (P=0.143) between the two surveys. As to assessment of the longitudinal diameter and epicenter, the percentage of respondents choosing gastroscopy increased from 53.1% (17/32) to 73.5% (25/34) (P=0.040). Regarding the landmark for EGJ in surgical specimens, the percentage of respondents choosing the dentate line increased from 59.4% (19/32) to 85.3% (29/34) (P=0.027). In 2022, 82.4% (28/34) respondents reported that they were "skilled" in inferior mediastinal lymph node dissection for AEG. As to a safe proximal margin, the percentage of respondents choosing "≥1 cm, <2 cm" increased from 6.3% (2/32) to 26.5% (9/34) (P=0.158). Regarding the means of determining a safe proximal margin when the tumor is not infiltrating the serosa, the percentage of respondents choosing "intraoperative palpation" increased from 3.1% (1/32) to 23.5% (8/34), whereas those choosing "intraoperative gastroscopy" decreased from 62.5% (20/32) to 35.3% (12/32) (P=0.018). Conclusions: In the CLASS10 research team, the most commonly adopted definition of AEG was the Chinese expert consensus definition. We identified an increasing trend for choosing "endoscopy" and the "dentate line" when diagnosing AEG. Further, the definition of a safe proximal margin had decreased.