In Siewert classification of oesophagogastric junction (OGJ) tumours, a Type II tumour (true cardia carcinoma, epicentre 1 cm above to 2 cm below the OGJ) is surgically managed by which approach?
- A Total gastrectomy with D2 lymph node dissection (abdominal approach)
- B Ivor Lewis oesophagectomy (right thoracotomy and laparotomy with oesophagogastric anastomosis in the chest)
- C Extended total gastrectomy or transhiatal oesophagectomy, individualised to tumour characteristics ✓
- D Endoscopic submucosal dissection (ESD) if T1 lesion
Explanation
Siewert Type II (true cardia) adenocarcinoma can be resected by either extended total gastrectomy (with resection of the distal oesophagus) via an abdominal approach or transhiatal oesophagectomy, depending on tumour extent, surgeon experience, and nodal involvement. There is ongoing controversy between these approaches. Type I tumours (distal oesophageal adenocarcinoma) are best treated by Ivor Lewis or McKeown oesophagectomy. Type III (sub-cardia gastric) tumours are treated by extended total gastrectomy. Option D applies only to early (T1a/T1b) tumours and not generally.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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