Prospective evaluation of radical surgery for adenocarcinoma of oesophagogastric junction: real-world insights from the CLAEG study
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The optimal surgical strategy for adenocarcinoma of oesophagogastric junction (AEG) remains debated, particularly regarding lymphadenectomy extent, gastrectomy type and surgical approach, with real-world prospective evidence being scarce. OBJECTIVE: To map lymph node metastasis (LNM) patterns and assess surgical outcomes in a large multicentre cohort of patients with AEG undergoing radical resection. DESIGN: The Chinese League of Adenocarcinoma of Esophagogastric Junction (CLAEG) registry, initiated in 2022 across 44 high-volume Chinese centres, prospectively enrolled AEG patients. This analysis included 2044 radical resections, with LNM assessed by station, stratified by Siewert type and neoadjuvant therapy. Surgical outcomes were compared between total versus proximal gastrectomy and laparoscopic versus open resection. RESULTS: Most tumours were Siewert type II (64.6%) or III (33.4%). LNM was substantially higher in abdominal than mediastinal stations; category-1 nodes (metastasis, >10%) comprised stations 1, 2, 3, 4, 7, 8a, 9 and 11p. The LNM rates for mediastinal stations were 2.77% (No. 110), 0.71% (No. 111) and 0.68% (No. 112). Patients who received neoadjuvant therapy had lower LNM rates, indicating nodal downstaging. Among those undergoing gastrectomy, patients who underwent total gastrectomy had a lower postoperative complication rate than those who underwent proximal gastrectomy (14.8% vs 21.0%; p=0.001) and achieved more extensive lymphadenectomy. Compared with open surgery, patients who underwent laparoscopic resection experienced faster postoperative recovery without higher complication rates (16.5% vs 17.3%). No perioperative mortality occurred. CONCLUSION: The CLAEG study shows that abdominal lymphadenectomy should be prioritised in AEG, with neoadjuvant therapy, total gastrectomy and laparoscopy associated with favourable short-term outcomes.
Source: Gut
Authors: Jiabin Zheng, Yuanfang Li, Yuanfang Li, Lin Fan, Chaohui Zheng, Su Yan, Ziyu Li, Hao Chen, Wenqing Hu, Jiangpeng Wei, Quan Wang, Zhi Li, Wenbin Zhang, Weidong Zang, Wenbin Yu, Lei Lian, Zhaojian Niu, Yongyou Wu, Yigao Wang, Jia-Ming Zhu, Shengxun Mao, Bo Wei, Changqing Jing, Kuan Wang, Wei Wang, Linghua Zhu, Kewei Jiang, Bo Wei, Zhengrong Li, Jun You, Bo Yi, Jian Zhang, Lu Zang, Hua Huang, Shaobin Duan, Gaoping Zhao, Guoqiang Wang, Pin Liang, Wu Song, Fanghai Han, Hankun Hao, Fenglin Liu, He Huang, Qingxing Huang, Yong Li, Yong Li
Institutions: Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Southern Medical University, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Fujian Medical University, Union Hospital, Qinghai University, Qinghai University Affiliated Hospital, Zhengzhou University, Peking University Cancer Hospital, Henan Cancer Hospital, First Affiliated Hospital of Nanchang University, Nanfang Hospital, Changzhi Medical College, Xijing Hospital, Air Force Medical University, Jilin University, First Hospital of Jilin University, Xinjiang Medical University, Tumor Hospital of Xinjiang Medical University, Fujian Provincial Cancer Hospital, Shandong University, Qilu Hospital of Shandong University, Sun Yat-sen University, Affiliated Hospital of Qingdao University, Second Affiliated Hospital of Soochow University, Anhui Medical University, First Affiliated Hospital of Anhui Medical University, First Hospital of China Medical University, China Medical University, Second Affiliated Hospital of Nanchang University, Second Hospital of Nanchang, Chinese PLA General Hospital, Third Affiliated Hospital of Sun Yat-sen University, Shandong Provincial Hospital, Shandong First Medical University, Harbin Medical University, Third Affiliated Hospital of Harbin Medical University, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Peking University People's Hospital, Xiamen University, First Affiliated Hospital of Xiamen University, Jiangxi Provincial Cancer Hospital, Nanchang Medical College, First Affiliated Hospital Zhejiang University, Shanghai Jiao Tong University, Ruijin Hospital, Shanghai Medical College of Fudan University, Shanxi Medical University, Fudan University, Fudan University Shanghai Cancer Center, First Hospital of Shanxi Medical University, University of Electronic Science and Technology of China, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Dalian Medical University, First Affiliated Hospital of Dalian Medical University, The First Affiliated Hospital, Sun Yat-sen University, Huashan Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Awards: G2811823705, G6508634797
OpenAlex ID: W7126054795