Select the topography of the tumour centre relative to the OGJ to visualize the Siewert staging profile.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Topographical classification of adenocarcinomas involving the Oesophagogastric Junction (OGJ)
To guide the surgical approach (Oesophagectomy vs. Total Gastrectomy)
Standardizing pre-operative reporting for multi-disciplinary team (MDT) discussion
Defining the Center
Classification is based on the anatomical epicenter (center) of the tumour relative to the gastric cardia.
Section 2
Formula & Logic
The 3 Siewert Types
Type I
Epicenter 1–5cm above the GOJ. (Distal Esophageal)
Type II
Epicenter 1cm above to 2cm below the GOJ. (True Cardia)
Type III
Epicenter 2–5cm below the GOJ. (Subcardial Gastric)
Surgical Guidance (Common Practice)
01
Type I: Treated as Esophageal cancer; Transthoracic Oesophagectomy.
02
Type II: Transitional; May be treated with Oesophagectomy or Extended Gastrectomy.
03
Type III: Treated as Gastric cancer; Total or Extended Gastrectomy + D2 lymphadenectomy.
Section 3
Pearls/Pitfalls
The "Conflict Zone" (Type II)
Siewert Type II remains the most debated category. Modern practice often leans toward oesophagectomy (e.g., Ivor-Lewis) because of the high risk of mediastinal lymph node involvement. However, if the tumour is small and localized to the cardia, an extended total gastrectomy may be sufficient.
AJCC 8th Edition Update
The AJCC 8th edition stages Siewert I and II according to the Oesophageal staging system. Siewert III is specifically staged using the Gastric staging system.
Clinical Pearls
Accurate classification often requires a combination of Endoscopy, EUS, and CT with oral contrast
Type I is almost exclusively associated with Barrett's Oesophagus
Type III tumours have a gastric biological phenotype and higher rates of peritoneal spread
Section 4
Next Steps
Treatment Strategy
01
Type I/II: CROSS trial (Neoadjuvant Chemoradiotherapy) followed by surgery.
02
Type III: FLOT trial (Perioperative Chemotherapy) followed by surgery.
Complementary Tools
Oesophageal TNM Staging
Gastric TNM Staging
Prague C&M Criteria
Section 5
Evidence Appraisal
The Foundational System
Classification of adenocarcinoma of the esophagogastric junction.
Siewert JR et al. • British Journal of Surgery. 1998;85(11):1457-9. The refined anatomical categorization.
Developed by Professor Siewert in Munich, Germany. He recognized that "OGJ" was being used too vaguely, leading to mismatched surgical outcomes. His topographical system provided the first objective map for differentiating thoracic vs. abdominal surgical priorities.
