Chirurgie (Springer-Lehrbuch) (German Edition) (German) 7., komplett überarb. u. teilw. neu verfaßte Aufl. Edition. by J. Rüdiger Siewert (Author), M. Allgöwer. Dr. Siewert is somewhat modest—he has clearly redefined adenocarcinoma of . Correspondence: J. Rüdiger Siewert, MD, Chirurgische Klinik und Poliklinik. Buy Praxis Der Viszeralchirurgie: Endokrine Chirurgie by Siewert J. R. (ISBN: ) from Amazon's Book Store. Free UK delivery on eligible orders.


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This article has been cited by other articles in PMC. Summary Background Data Because of its borderline location between the stomach and esophagus, the choice siewert chirurgie surgical strategy for patients with adenocarcinoma of the esophagogastric junction is controversial.

Methods In a large single-center series of 1, consecutive patients with adenocarcinoma of the esophagogastric junction, the choice of surgical approach was based on the location of the tumor center or tumor mass.

Treatment of choice was esophagectomy for type I tumors adenocarcinoma of the distal esophagus and extended siewert chirurgie for type II tumors true carcinoma of the cardia and type III tumors subcardial gastric cancer infiltrating the distal esophagus. Demographic data, morphologic and histopathologic tumor characteristics, and long-term survival rates were compared among the three tumor types, focusing on the pattern of lymphatic spread, the outcome of surgery, and prognostic factors in patients with type II tumors.

Adenocarcinoma of the Esophagogastric Junction

Results There were marked differences in sex distribution, associated intestinal metaplasia in the esophagus, tumor grading, tumor growth pattern, and stage distribution between the three tumor types. The postoperative siewert chirurgie rate was higher siewert chirurgie esophagectomy than extended total gastrectomy.

On multivariate analysis, a complete tumor resection R0 resection and the lymph node status pN0 were the dominating independent prognostic factors for the entire patient population and in the three tumor types, irrespective of the surgical approach.

In patients with type II tumors, the pattern of lymphatic spread was primarily directed toward the paracardial, lesser curvature, and left gastric artery nodes; esophagectomy offered no survival benefit over extended gastrectomy in these patients.

Conclusion The classification of adenocarcinomas of the esophagogastric junction into type I, II, and III tumors shows marked differences between the tumor types and provides a useful tool for selecting the surgical approach.

For patients with type II tumors, esophagectomy offers no advantage over extended gastrectomy if a complete tumor resection can be achieved. In siewert chirurgie Western world, the prevalence of adenocarcinoma of the esophagogastric junction is rising at an alarming rate.

Praxis Der Viszeralchirurgie: Endokrine Chirurgie : J R Siewert :

This is reflected in the vastly differing surgical approaches and long-term survival rates after surgical resection reported in the literature. At a recent consensus conference of the International Gastric Cancer Association and the International Society for Diseases of the Esophagus, all participating experts agreed that this classification should form the basis for defining, assessing, and reporting treatment of adenocarcinoma of the esophagogastric junction.

In this article we report an analysis of a large and homogeneously classified population of consecutive patients with adenocarcinoma of the esophagogastric junction treated according to these guidelines, with a siewert chirurgie on the pattern of lymphatic spread, the outcome of surgical treatment, and prognostic factors in patients with type II tumors.

Adenocarcinoma of the esophagogastric junction was defined as a tumor whose center siewert chirurgie within 5 cm proximal and distal of the anatomical cardia.

Praxis Der Viszeralchirurgie: Endokrine Chirurgie

Based on the anatomical location siewert chirurgie the tumor center or, in patients with advanced tumors, the tumor mass, all tumors were prospectively classified into the categories noted above. The prospectively collected data included demographic parameters, histomorphologic tumor characteristics, the presence of associated intestinal metaplasia in the distal esophagus Barrett esophagusthe type of resection, postoperative day death rate, the depth of tumor invasion pTthe pN category, the number and location of positive and siewert chirurgie lymph nodes, siewert chirurgie pM category, and the presence of residual disease on intraoperative assessment and histopathologic analysis of the removed specimen.

Surgical Approach The choice of surgical approach was based on the tumor type and the goal of achieving complete macroscopic and microscopic tumor resection.

In general, a radical transmediastinal or transthoracic en bloc esophagectomy with resection of the proximal stomach was the procedure of choice in patients with type I tumors.

If, based siewert chirurgie preoperative staging or the intraoperative findings, complete tumor resection by a transabdominal approach siewert chirurgie unlikely, an esophagectomy with proximal gastric resection was performed. Radical transmediastinal esophagectomy and resection of the proximal stomach was performed by a laparotomy and wide exposure of the lower posterior mediastinum by anterior splitting of the diaphragmatic hiatus and a left cervical incision.

Lymphadenectomy comprised an en bloc removal of all lymphatic tissue in the lower posterior mediastinum, along the cardia, proximal two thirds of the lesser curvature, and the siewert chirurgie, and along the common hepatic and splenic artery toward the celiac axis.


Reconstruction after transmediastinal or transthoracic esophagectomy siewert chirurgie performed with a narrow gastric tube or colon interposition and a cervical or high intrathoracic anastomosis.

Extended total gastrectomy always included wide splitting of the diaphragmatic hiatus, transhiatal resection of the distal esophagus, and en bloc lymphadenectomy of the lower posterior mediastinum, in addition to a formal D2 lymphadenectomy i.

An end-to-side esophagojejunostomy performed with a circular stapler and Roux-en-Y bile diversion was the reconstruction procedure of choice after extended total gastrectomy.

Histopathologic Assessment of the Removed Specimen and Lymph Nodes Resection specimens were assessed by an experienced pathologist.

All removed lymph nodes were counted, assessed siewert chirurgie, and identified according to their location. Follow-Up The survival status of our patients was ascertained between October and December Survival siewert chirurgie were available for of the 1, patients

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