A 55-year-old man with Siewert type II adenocarcinoma of the oesophagogastric junction (OGJ) is found on staging to have T3N1M0. What defines Siewert type II and what is its recommended surgical approach?

• A Siewert II = tumour epicentre 1-5 cm below the OGJ (true cardia); transhiatal extended gastrectomy or Ivor Lewis oesophagogastrectomy are both acceptable
• B Siewert II = tumour epicentre within 1 cm above and 2 cm below the OGJ (true cardia); total gastrectomy via transabdominal approach is standard ✓
• C Siewert II = tumour epicentre 1-5 cm above the OGJ (lower oesophagus); Ivor Lewis oesophagogastrectomy only
• D Siewert II = tumour at the OGJ (squamocolumnar junction); total gastrectomy with Roux-en-Y reconstruction

Explanation

Siewert classification of OGJ adenocarcinomas: Type I (Barrett's oesophagus origin, 1-5 cm above the OGJ) — treated as oesophageal cancer; Type II (true cardia tumour, within 1 cm above to 2 cm below OGJ) — treated with total gastrectomy or extended gastrectomy, transhiatal resection; Type III (subcardia gastric cancer, 2-5 cm below OGJ) — total gastrectomy. Type II tumours are managed by total gastrectomy via transabdominal approach ± lower oesophageal resection with adequate margins; in centres with expertise, Ivor Lewis (for tumours with significant oesophageal extension) may be used. The specific distinction tested is that Siewert II is the 'true cardia' (epicentre within 1 cm above and 2 cm below the anatomical OGJ).

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.