Efficacy of surgical resection of left and right transthoracic approaches for middle thoracic esophageal squamous cell carcinoma

Abstract

Background and Objective: For squamous cell carcinoma of the middle thoracic esophagus, surgical resection of left or right transthoracic approach has its advantages and disadvantages, respectively. This study was to compare the outcomes between the two approaches. Methods: A total of 482 consecutive patients with middle thoracic esophageal squamous cell carcinoma (ESCC) underwent transthoracic esophagectomy between January 1999 and June 2005. These patients were divided Into left transthoracic approach group (n=350) and right transthoracic approach group (n=132). Surgical resection rate, postoperative complications, lymphadenectomy, recurrence pattern, disease-free survival, and overall survival of the two groups were compared retrospectively. Results: The surgical resection rate was 92.0% in left approach group and 92.4% in right approach group (P= 0.878). The incidence of postoperative complications was higher in right approach group than in left approach group (57.6% vs. 35.4%, P<0.001). The average number of lymph nodes resected was 11.8±6.6 in left approach group and 16.3±8.0 in right approach group (P<0.001). Lymphatic recurrence rate was lower in right approach group than in left approach group (51.1% vs. 69.6%,P= 0.028), especially occurring to mediastinal lymph nodes (15.6% vs. 38.4%, P=0.005). Three-year disease-free survival was higher in right approach group than in left approach group (22.92±0.74 vs. 25.09±1.22, P=0.039). Conclusions: Although left transthoracic resection reduced the incidence of postoperative complications, esophagectomy of right transthoracic approach was more effective in survival improvement.