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.
目的： 了解中国胃外科医生群体［中国腹腔镜胃肠外科研究组（CLASS）-10研究］关于食管胃结合部腺癌（AEG）的临床诊治观念。 方法： 采用现况调查方法，在CLASS-10研究组微信群（包括国内32家中心的研究者和研究助理构成，参与人员均为胃外科医生）发放调查问卷，调查分别在研究启动前（2020年）和研究中期（2022年）进行。调查内容主要针对AEG的外科诊治观念进行编制，主要包括诊断、外科治疗及围手术期管理3个方面。在第2次调查时，在首次问卷基础上，增加了对受访者职称、医院类型和AEG定义的调查内容；在外科治疗部分，针对CLASS-10研究涉及的下纵隔淋巴结清扫的观点进行了补充调查。记录受调查者对AEG的临床诊治观念，并对两次调查中诊治观念的差异进行分析。 结果： 两次调查分别回收问卷32份和34份。关于AEG的定义，中国专家共识的接受度最高（18/34，52.9%），即肿瘤中心处于食管胃交界（EGJ）上下5 cm区间以内的腺癌并跨越或接触食管胃结合部。关于术前对EGJ的判断依据，选择齿状线的比例由68.8%（22/32）升至88.2%（30/34），差异无统计学意义（P=0.143）。对于AEG长径及中心点的判断，采用胃镜的比例由53.1%（17/32）升至73.5%（25/34），差异有统计学意义（P=0.040）。对于术后标本EGJ的判断，选择齿状线的比例由59.4%（19/32）升至85.3%（29/34），差异有统计学意义（P=0.027）。2022年时，对于下纵隔淋巴结清扫，82.4%（28/34）的受访者表示熟练掌握下纵隔淋巴结清扫技术。对于AEG手术安全近端切缘距离，选择“≥1 cm，<2 cm”的比例由6.3%（2/32）升至26.5%（9/34），但差异无统计学意义（P=0.158）。对于未侵犯浆膜层的AEG确定近端切缘的方式，选择“术中触诊”的比例由3.1%（1/32）升至23.5%（8/34），选择“术中胃镜”的比例由62.5%（20/32）降至35.3%（12/34），差异有统计学意义（P=0.018）。 结论： 在CLASS10研究组中，AEG中国专家共识定义的接受度较高。对于AEG的诊断，选择胃镜检查及齿状线的辨认的比例有增高趋势。对于AEG的外科治疗，安全近端切缘距离有减少趋势。.