Esophagectomy in Middle and Lower Thoracic Esophageal Cancer Patients Through Left Versus Right Transthoracic Approach

Esophageal carcinoma is an aggressive malignant disease with poor prognosis. Surgical resection remains the most effective method for this malignancy. Although different approaches have been studied for the surgical resection of thoracic esophageal cancer, little evidence has been achieved due to lack of large scale multicenter randomized trials with regard to this issue: whether left transthoracic approach or right transthoracic approach is the optimal surgical approach for treating middle and lower thoracic esophageal cancer without upper mediastinal lymph node metastasis. The purpose of this study is to compare the postoperative local recurrence rate and long-term outcome of esophagectomy through left and right transthoracic approach in the middle and lower thoracic esophageal cancer patients without preoperative upper mediastinal lymph node metastasis.

Sex

All

Minimum age

18 Years

Maximum age

75 Years

Inclusion Criteria:

1. Patients with histologically proved squamous cell esophageal cancer without any previous anti-tumor therapy;
2. The preoperative clinical TNM stage: cT1b-3N0-1M0;
3. Adequate function of heart, lung, liver, brain and kidney, which can tolerate esophagectomy either through left or right thoracotomy;
4. Without any preoperative distant metastases confirmed by preoperative examination such as chest and abdominal CT, brain MRI and bone scan or PET-CT;
5. No evidence showing suspicious upper mediastinal lymph node metastasis (short diameter of LN \<0.8cm or shortest diameter / longest diameter \<0.65) by the thoracic and abdominal CT and endoscopic ultrasonography(EUS).
6. Willing to participate the clinical trial and sign informed consent before being enrolled into clinical trail.

Exclusion Criteria:

1. Non-squamous cell esophageal carcinoma or has any previous anti-cancer therapy before surgery;
2. The preoperative clinical TNM stage reaches: N2-3 or M1;
3. Inadequate cardiopulmonary, liver, brain and kidney function for tolerating the esophagectomy ;
4. Previous history of malignancy;
5. Unwilling to participate the clinical trial and refuse to sign informed consent

• DERIVEDMao YS, Gao SG, Li Y, Hao AL, Liu JF, Li XF, Rong TH, Fu JH, Ma JQ, Xu MQ, Zhang RQ, Xiao GM, Fu XN, Chen KN, Mao WM, Liu YY, Liu HX, Zhang ZR, Fang Y, Fu DH, Wei XD, Yuan LG, Muhammad S, Wei WQ, Chiu PW, Lloyd S, Schlottmann F, Meredith K, Pimiento JM, Gao YB, He J. Efficacy and safety of esophagectomy via left thoracic approach versus via right thoracic approach for middle and lower thoracic esophageal cancer: a multicenter randomized clinical trial (NST1501). Ann Transl Med. 2022 Aug;10(16):904. doi: 10.21037/atm-22-3810. PMID 36111056