Published online Mar 27, 2014. doi: 10.4240/wjgs.v6.i3.38
Revised: December 21, 2013
Accepted: January 17, 2014
Published online: March 27, 2014
Processing time: 162 Days and 18.8 Hours
Gastroesophageal junction cancer has an increasing incidence in western countries. It is inoperable when first manifested in more than 50% of cases. So, palliation is the only therapeutic option for the advanced disease to relieve dysphagia and its consequences in weakened patients with an estimated mean survival under 6 mo. This article has tried to identify trends focusing on current information about the best palliative treatment, with an emphasis on the role of stenting. Self-expanding stent placement, either metal or plastic, is the main management option. However, this anatomical location creates some particular problems for stent safety and effectiveness which may be overcome by properly designed novel stents. The stents ensure a good quality of life and must be preferred over other alternative methods of loco-regional modalities, i.e., external radiation, laser thermal or photodynamic therapy. Although stent placement is generally a simple, safe and effective method, there are sometimes complications, increasing the morbidity and mortality rate. Bypass operative procedures have now been abandoned as a first choice. The stomach instead of the colon must be used for a bypass operation when it is needed. Chemotherapy, despite the toxicity, and intraluminal radiation (brachytherapy) have a well-defined role.
Core tip: The topic is interesting and this manuscript contains the most recent data briefly highlighting it. More than half of the patients with gastroesophageal junction cancer present with inoperable disease at the time of diagnosis so they need palliative treatment to relieve dysphagia and its consequences. Stent placement ensures good quality of life during the short survival time but it has some additional specific problems in this particular location.