The Siewert classification of gastroesophageal junction (GEJ) adenocarcinomas guides the surgical approach. A tumor centered 3 cm below the GEJ in the cardia is classified as which Siewert type, and what is the recommended operation?
- A Siewert Type I (distal esophageal) — subtotal esophagectomy
- B Siewert Type III (subcardial gastric) — total gastrectomy with D2 lymphadenectomy ✓
- C Siewert Type II (true cardia) — total gastrectomy with distal esophagectomy
- D Siewert Type II — Ivor Lewis esophagectomy is the preferred approach
Explanation
The Siewert classification: Type I = epicenter 1-5 cm above GEJ (distal esophageal, usually Barrett's-related); Type II = epicenter 1 cm above to 2 cm below GEJ (true cardia/junctional); Type III = epicenter 2-5 cm below GEJ (subcardial gastric). A tumor centered 3 cm below the GEJ is Siewert Type III. Management: Type III is treated like gastric cancer — total gastrectomy with D2 lymphadenectomy and Roux-en-Y reconstruction. Type I is treated with esophagectomy. Type II can be managed by either approach, with either total gastrectomy or esophagogastrectomy (Ivor Lewis).
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.