The aim of the work paper is to present the treatment methods of the esophago-gastric junction adenocarcinoma, (AC) based on our experience and literature data. The later reveal many novelties about AC prophylaxis through Barrett's esophagus (BE) treatment, using proton pomp inhibitors or antireflux surgical procedures, the progress of the endoluminal ablative methods for intestinal metaplasia, as well as a new surgical approach for advances tumors based on Siewert classification. Surgical procedure selection at patients with resectable tumours should be based on the tendency of esophago-gastric junction adenocarcinomas to extend on longitudinal axis, at the submucosa level and the possibility of abdomino-mediastinal lymph nodes metastasis. In located disease, tumoral resection R0 with abdominal and mediastinal lymph nodes dissection represents the optimal therapy, because it confers the best chance of cure. Preoperative radio-chemotherapy appears to increase the chance for a curative resection at the patients with advanced tumors. The main therapeutical purpose in non-responding patients is the palliation of dysphagia and malnutrition.