Right versus left transthoracic approach for lymph node-negative esophageal squamous cell carcinoma

Abstract

BackgroundTo compare the right and left transthoracic approach on the post-operative survival of patients with lymph node-negative esophageal squamous cell carcinoma.MethodsSix hundred and ninety-five ESCC patients who underwent esophagectomy between 1990 and 2005 were retrospectively enrolled in the present study and were confirmed by histology to be of no lymph node metastasis. Those who had received neoadjuvant chemotherapy or radiotherapy were excluded from the study. Patients were divided into two groups, the left (n = 545) and right (n = 150) transthoracic groups. The follow-up duration ranged from 1 to 20 years with a mean of 7 years. Kaplan–Meier and univariate and multivariate Cox proportional hazards were used for analysis.Results3- and 5-year CSS rates were 62.0 % and 44.0 % in the left group, while the corresponding figures in the right group were 56.0 % and 40.0 %(P < 0.05). The overall survival for the two groups was significantly different (P = 0.045). Survival analyses were stratified by stages, which found that the favorable survival advantage was not present. When the survival curves were stratified by tumor locations, a significant difference was not revealed. Surgical approaches were regarded as one of the prognostic factors in the univariate analysis (P = 0.019). However, this significance could not be confirmed in multivariate Cox regression analysis (P = 0.193).ConclusionsThe left transthoracic approach is superior in some aspects to the right transthoracic approach regarding surgical and oncological outcomes in the treatment of lymph node negative ESCC.

Comparison of short‐term outcomes and three yearsurvival between total minimally invasiveMcKeown and dual‐incision esophagectomy

“…In contrast, in China, the most commonly used surgical approaches for the resection of EC include the McKeown and Sweet approaches . Recently, the Ivor Lewis and MIE approaches have been increasingly adopted in China . Different surgical approaches between China and other countries may be multifactorial.…”

“…However, for EC patients with negative upper mediastinal LNs who are in need of esophagectomy, there is debate over the optimal approach. For example, a recent study comparing right and left transthoracic approaches on the survival of patients with LN negative esophageal squamous cell carcinoma demonstrated that the left transthoracic approach is superior to the right in terms of surgical and oncological outcomes …”

Multimodale Therapie des Ösophaguskarzinoms

“…Ist der Magen nicht als Conduit verfügbar, kann alternativ Kolon verwendet werden [2]. Für das Standardverfahren ist ein linksthorakaler Zugang möglich, jedoch wird aufgrund der deutlich besseren Exposition der thorakalen Lymphknoten in der Regel ein höherer rechtsthorakaler Zugang gewählt (Ivor-Lewis-Operation, [46]). Wegen der recht hohen Komplikationsrate an der Ösophagusanastomose (historisch bis zu 25 %) und der oft schwierigen Therapieoptionen bei intrathorakaler Leckage wurde lange Zeit die fast komplette Entfernung des Ösophagus mit Anlage einer zervikalen Anastomose (McKeowan-Operation) favorisiert, auch wenn dies onkologisch nicht erforderlich war.…”

The impact of operative approaches on outcomes of middle and lower third esophageal squamous cell carcinoma

“…Ma et al demonstrated that operation approach (left or right approach) was not risk factor for long term survival by Cox regression analysis in patients after esophagectomy, although univariable analysis showed that operation approach was an unfavorable prognostic factor for long term survival. While other factors such as tumor staging and age were unfavorable prognostic factors for long term survival in patients after esophagectomy (10). Recently, Li et al conducted a randomized controlled study comparing the difference in postoperative complications between Sweet and Ivor approached and concluded that both approaches are safe procedures with low mortalities.…”

“…Fu et al reported that it is easier to perform systemic lymphadenectomy via right thoracic approach than left approach and the local recurrence is reduced and long-term survival improved (9). On the contrary, Ma J and Ma Q reported that Sweet approach was associated with reduced duration of operation, decreased complication rate, similar long term survival in esophageal cancer patients (7,10). A meta-analysis including 15 studies demonstrated that two approaches had similar long term effect (8).…”