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Langenbeck's Archives of Surgery

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01-12-2017 | REVIEW ARTICLE

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

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

Published in: Langenbeck's Archives of Surgery | Issue 8/2017

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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Title: Surgical approaches to adenocarcinoma of the gastroesophageal junction: the Siewert II conundrum
Authors: Andrew M. Brown
Danica N. Giugliano
Adam C. Berger
Michael J. Pucci
Francesco Palazzo
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 8/2017
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-017-1610-9

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Springer Medicine

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

Abstract

Background

Purpose

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Purpose

Conclusions

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