34. EXTENDED RIGHT THORACIC APPROACH COMPARED WITH LIMITED LEFT THORACIC APPROACH FOR ESOPHAGEAL CANCER: TEN-YEAR SURVIVAL OF A PROSPECTIVE RANDOMIZED TRIAL

Abstract

Abstract Objective Esophagectomy can be performed using various surgical techniques. This study was conducted to understand the impact of surgery on long-term survival for esophageal cancer. Methods Between 2010 and 2012, 300 patients were prospectively recruited to compare the outcomes of esophagectomy using the right and left thoracic approaches. Based on pathological findings, 146 patients with squamous cell carcinoma in the right thoracic arm and 140 in the left arm were included in this analysis. Disease-free survival (DFS) and overall survival (OS) were compared between the two arms after a 10-year follow-up period. Results The median DFS was 92 months in the right thoracic arm and 41 months in the left arm (hazard ratio (HR), 0.73; 95% confidence interval (CI), 0.54–0.99; P = 0.045), with the cumulative 10-year DFS of 48% and 38%, respectively. The median OS was 136 months in the right thoracic arm and 99 months in the left arm (HR, 0.75; 95% CI, 0.54–1.04; P = 0.081), with cumulative 10-year OS rates of 52% and 44%, respectively. DFS and OS were comparable between the two arms for patients without lymph node metastasis. Conversely, for patients with lymph node metastasis, 10-year DFS of the right and left thoracic arms were 33% and 21%, respectively (P = 0.018), and 10-year OS were 37.9% and 25.8%, respectively (P = 0.012). Conclusion Compared to esophagectomy via the left thoracic approach, patients who underwent esophagectomy via the right thoracic approach had better 10-year survival rates, and the survival benefit was significant for those with lymph node metastasis.