• Bin Li, Hong Hu, Yawei Zhang, Jie Zhang, Longsheng Miao, Longfei Ma, Xiaoyang Luo, Yiliang Zhang, Ting Ye, Hecheng Li, Jianhua Zhou, Yuan Li, Lei Shen, Kuaile Zhao, Min Fan, Zhengfei Zhu, Jialei Wang, Jie Xu, Youjia Deng, Qiong Lu, Huixun Jia, Xinghua Cheng, Hang Li, Yang Zhang, Chenguang Li, Yunjian Pan, Shilei Liu, Haichuan Hu, Longlong Shao, Yihua Sun, Jiaqing Xiang, and Haiquan Chen.
• Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
• Ann. Surg. 2018 May 1; 267 (5): 826-832.

ObjectiveTo investigate whether survival is improved by using the right thoracic approach (extended lymphadenectomy) compared with the left thoracic approach (limited lymphadenectomy) for esophageal cancer.BackgroundThe optimal surgical technique for esophageal cancer remains unclear.MethodsBetween May 2010 and July 2012, 300 patients with middle and lower thoracic esophageal carcinoma were randomized to receive esophagectomy through either the right or left thoracic approach. Of these, 286 patients with squamous cell carcinoma determined by postoperative pathology were included in this analysis. Disease-free survival (DFS) and overall survival (OS) were compared between the right (n = 146) and left thoracic groups (n = 140).ResultsThe median follow-up was 55.9 months [95% confidence interval (CI): 53.1-58.6]. The 3-year DFS rates were 62% and 52% in the right and left thoracic arms, respectively [hazard ratio (HR) 0.709; 95% CI, 0.506-0.995; P = 0.047, log-rank test]. The 3-year OS rates were 74% and 60%, respectively (HR, 0.663; 95% CI, 0.457-0.961; P = 0.029). Subgroup analyses revealed longer DFS in the right thoracic arm (vs left thoracic arm) in patients with lymph node involvement (HR, 0.632; 95% CI, 0.412-0.969, P = 0.034), but not in patients without lymph node involvement (HR, 0.757; 95% CI, 0.434-1.320, P = 0.325), and in patients with R1-2 resection margins (HR, 0.495; 95% CI, 0.290-0.848, P = 0.009), but not R0 margins (HR, 0.944; 95% CI, 0.603-1.477, P = 0.801).ConclusionsCompared with the left thoracic approach, the right thoracic approach associated with increased DFS and OS in esophageal squamous cell carcinoma patients, particularly in those with lymph node involvement and/or R1-2 resection margins.

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