Upper GI 2017

3/28/2017

EGJ tumor (TNM 7 th ed.) Oesophagus (ICD-O C15) Includes Oesophagogastric junction (C16.0)

OESOPHAGO-GASTRIC JUNCTIONALADENOCARCINOMA

5 cm

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.

SIEWERT AEG-Classification

EORTC Consensus St Gallen 2012

Type I Adeno-Ca. Dist. Esoph. Type II True Cardia-Ca. Type III Subcardial Ca.

– Type I – Oesophago-gastrectomy

– Type II – Oesophago-gastrectomy or – Extended Total Gastrectomy

– Type I & II – Mediastinal Lymphadenectomy – 2 field

Focused on tumor-centre location

5 cm 5 cm

– Type III - Extended Total Gastrectomy

R.Siewert, Brit.J.Surg. 1998

Lutzetal Eur J Cancer 2012; 48: 2941-53

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surgicalauditgroup,January2011

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TheRoyalMarsden

Type II Definition

Survival in Type II according to surgery

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

Siewert et alAnn Surg 2002; 232: 353-61

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