The Siewert classification of adenocarcinoma at the gastro-oesophageal junction (GOJ) determines surgical approach. A Siewert Type II tumour is centred at the cardia. Which surgical approach is MOST appropriate?

• A Transhiatal oesophagectomy with cervical anastomosis
• B Ivor-Lewis oesophagectomy (right thoracotomy and laparotomy)
• C Total gastrectomy with distal oesophagectomy and D2 lymphadenectomy via transhiatal or thoracoabdominal approach ✓
• D Endoscopic submucosal dissection as it arises at the cardia

Explanation

Siewert classification: Type I = adenocarcinoma of distal oesophagus centred 1-5 cm above GOJ (treated as oesophageal cancer — Ivor-Lewis or McKeown); Type II = true carcinoma of the cardia centred 1 cm above to 2 cm below GOJ (treated by extended total gastrectomy with distal oesophageal resection via transhiatal or thoracoabdominal route); Type III = subcardial gastric cancer 2-5 cm below GOJ (treated as gastric cancer — total gastrectomy). D2 lymphadenectomy is the standard for gastric and Type II GOJ cancers to achieve adequate nodal clearance.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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