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

BACKGROUND To compare the right and left transthoracic approach on the post-operative survival of patients with lymph node-negative esophageal squamous cell carcinoma. METHODS Six 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. RESULTS 3- 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). CONCLUSIONS The 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.