62 / 1084
3/28/2017
4
OESOPHAGO-GASTRIC JUNCTIONALADENOCARCINOMA
EGJ tumor (TNM 7
th
ed.)
Oesophagus
(ICD-O C15)
Includes Oesophagogastric junction (C16.0)
Rules for Classification
•
A tumour the epicenter of which is within 5 cm
of the oesophagogastric junction and also
extends into the oesophagus is classified and
staged using the oesophageal scheme.
•
Tumours with an epicenter in the stomach
greater than 5 cm from the oesophagogastric
junction or those within 5 cm of the
oesophagogastric junction without extension in
the oesophagus are classified and staged using
the gastric carcinoma scheme.
5 cm
Type I
Adeno-Ca. Dist. Esoph.
Type II
True Cardia-Ca.
Type III
Subcardial Ca.
R.Siewert, Brit.J.Surg. 1998
SIEWERT
AEG-Classification
5 cm
5 cm
Focused on tumor-centre location
EORTC Consensus
St Gallen 2012
–
Type I – Oesophago-gastrectomy
–
Type II – Oesophago-gastrectomy or
–
Extended Total Gastrectomy
–
Type I & II – Mediastinal Lymphadenectomy
– 2 field
–
Type III - Extended Total Gastrectomy
Lutzetal
Eur J Cancer 2012; 48: 2941-53
TheRoyalMarsden
Type II Definition
Centre of tumour 2cm above or below gastro-oesophageal
junction
Defining the centre is NOT easy
endoscopy
imaging
Decisions based only on the centre ? Too simplistic
surgicalauditgroup,January2011
23
Survival in Type II according to surgery
24
Siewert et alAnn Surg 2002; 232: 353-61