# Siewert — Siewert classification of gastroesophageal junction adenocarcinoma

> Classifies adenocarcinoma by location relative to the gastroesophageal junction.

**Situação:** vigente · **Órgão:** Gastrointestinal · **Órgão emissor:** Surgical consensus · **Versão:** 1998 · **Ano:** 1998

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: CT, MRI
- Fonte primária: Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction (Siewert) (1998) — https://doi.org/10.1046/j.1365-2168.1998.00940.x
- Última verificação: 2026-06-26
- Última checagem: 2026-06-26

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| I | Type I | Adenocarcinoma of the distal esophagus whose center (epicenter) lies 1 to 5 cm above the anatomical gastroesophageal junction (GEJ); tumor burden is essentially esophageal. | Treated as an esophageal carcinoma: the standard surgical treatment is subtotal esophagectomy with proximal gastrectomy (endoscopic treatment only at very early stage). | Highest distant-metastasis rate of the three types in the cited series (~31.5% vs ~15% for II and ~4.6% for III); overall survival did not differ significantly by Siewert type (median OS ~26.6 months overall), with stage, grade and recurrence the independent OS predictors. | Criteria & figures: PMC5448566 (Cao et al.), Introduction (type I = 1-5 cm above GEJ) and Results/Discussion (metastasis ~31.5%; OS not different by type, median ~26.6 mo; stage/grade/recurrence independent OS factors). Surgery: same source ('subtotal esophagectomy and proximal gastrectomy'). | ✓ |
| II | Type II | True junctional (cardia) adenocarcinoma whose center lies within the zone from 1 cm above to 2 cm below the anatomical gastroesophageal junction (GEJ); the most controversial category as it straddles the true junction. | Distal esophagectomy with total gastrectomy is preferred for type II tumors (the source does not specify a lymphadenectomy level for type II). | Intermediate distant-metastasis rate (~15%) and intermediate disease-free survival (~14 months) in the cited series; overall survival did not differ significantly between Siewert types. | Criteria: PMC5448566 (Cao et al.), Introduction (type II = 1 cm above to 2 cm below GEJ). Management & figures: same source ('Distal esophagectomy and total gastrectomy are preferred in type II tumors'; metastasis ~15%; DFS ~14 mo; OS not different by type). | ✓ |
| III | Type III | Subcardial gastric adenocarcinoma that infiltrates the GEJ/distal esophagus from below, with its center located 2 to 5 cm below the anatomical gastroesophageal junction (GEJ); tumor burden is essentially gastric. | Treated as a gastric carcinoma: total gastrectomy with D1 (gastric-cancer-protocol) lymph node dissection. | Lowest distant-metastasis rate (~4.6%) and the longest disease-free survival (~20.8 months) of the three types in the cited series, though overall survival did not differ significantly by Siewert type (p=0.5). | Criteria: PMC5448566 (Cao et al.), Introduction (type III = 2-5 cm below GEJ). Management & figures: same source ('total gastrectomy and D1 lymph node dissection' for type III; metastasis ~4.6%; DFS ~20.8 mo; OS not different by type). | ✓ |

### Citações por categoria
- **I**: Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction (Siewert) (1998) — https://doi.org/10.1046/j.1365-2168.1998.00940.x · Criteria & figures: PMC5448566 (Cao et al.), Introduction (type I = 1-5 cm above GEJ) and Results/Discussion (metastasis ~31.5%; OS not different by type, median ~26.6 mo; stage/grade/recurrence independent OS factors). Surgery: same source ('subtotal esophagectomy and proximal gastrectomy').
- **II**: Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction (Siewert) (1998) — https://doi.org/10.1046/j.1365-2168.1998.00940.x · Criteria: PMC5448566 (Cao et al.), Introduction (type II = 1 cm above to 2 cm below GEJ). Management & figures: same source ('Distal esophagectomy and total gastrectomy are preferred in type II tumors'; metastasis ~15%; DFS ~14 mo; OS not different by type).
- **III**: Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction (Siewert) (1998) — https://doi.org/10.1046/j.1365-2168.1998.00940.x · Criteria: PMC5448566 (Cao et al.), Introduction (type III = 2-5 cm below GEJ). Management & figures: same source ('total gastrectomy and D1 lymph node dissection' for type III; metastasis ~4.6%; DFS ~20.8 mo; OS not different by type).


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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