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Erschienen in: Langenbeck's Archives of Surgery 8/2017

12.08.2017 | REVIEW ARTICLE

Surgical approaches to adenocarcinoma of the gastroesophageal junction: the Siewert II conundrum

verfasst von: Andrew M. Brown, Danica N. Giugliano, Adam C. Berger, Michael J. Pucci, Francesco Palazzo

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 8/2017

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Abstract

Background

The Siewert classification system for gastroesophageal junction adenocarcinoma has provided morphological and topographical information to help guide surgical decision-making. Evidence has shown that Siewert I and III tumors are distinct entities with differing epidemiologic and histologic characteristics and distinct patterns of disease progression, requiring different treatment. Siewert II tumors share some of the characteristics of type I and III lesions, and the surgical approach is not universally agreed upon. Appropriate surgical options include transthoracic esophagogastrectomy, transhiatal esophagectomy, and transabdominal extended total gastrectomy.

Purpose

A review of the available evidence of the surgical management of Siewert II tumors is presented.

Conclusions

Careful review of the data appear to support the fact that a satisfactory oncologic resection can be achieved via a transabdominal extended total gastrectomy with a slight advantage in terms of perioperative complications, and overall postoperative quality of life. Overall and disease-free survival compares favorably to the transthoracic approach. These results can be achieved with careful selection of patients balancing more than just the Siewert type in the decision-making but considering also preoperative T and N stages, histological type (diffuse type requiring longer margins that are not always achievable via gastrectomy), and the presence of Barrett’s esophagus.
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Metadaten
Titel
Surgical approaches to adenocarcinoma of the gastroesophageal junction: the Siewert II conundrum
verfasst von
Andrew M. Brown
Danica N. Giugliano
Adam C. Berger
Michael J. Pucci
Francesco Palazzo
Publikationsdatum
12.08.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
Langenbeck's Archives of Surgery / Ausgabe 8/2017
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-017-1610-9

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