Survival Analysis In The Middle And Lower Thoracic Esophageal Cancer Without Suspected Lymph Node Metastasis In Preoperative Examinations After Surgical Treatment Through Either Left Or Right Thoracic Approach

Objective:Esophageal cancer have high incidence and mortality in our country,at present,the main treatment of esophageal cancer is still surgery-based compreh ensive treatment,and surgery is still the most effective treatment.The modes of s urgical treatment for esophageal cancer are complex and diverse,and the surgical approaches can be mainly divided into the left thoracic approach and right thoraci c approach.According to the results reported in current literatures,the long-term s urvival of the patients treated through right approach was apparently better that t hat through left thoracic approach,but no significant difference between two grou ps.Up to now,for the thoracic esophageal cancer patients without suspected me diastinal lymph node metastasis in preoperative examinations,there is no definite conclusion of how to select the approach,and further studies are still needed to v erify it.Methods:The data of 403 cases with complete resection and two-field lymph no de dissection from January,2011 to December,2011 in the Cancer Hospital,CA MS was retrospectively reviewed and analyzed.Propensity matched analysis(PS M)and Life-table in SPSS 22.0 and Stata 14.0 were used to analyze thesurvival.Results:Totally,403 cases were surgically treated either via left or right thoracic approach,among of them,282 cases through left approach with 5-year survival rate of 37%,121 cases through right approach with 5-year survival rate of 39%(P=0.908).The overall 5-year survival rate of this series was 38%.The survival of the patients without suspected lymph node metastasis in the upper mediastinum based on the preopreative examinations 256 cases through left approachwith 5-year survival rate of 38%,88 cases through right approach with 5-year survival rate of 43%(P=0.404)..The survival analysis after PSM 110 cases through left approachwith 5-year survival rate of 32%,110 cases through right approach with 5-year survival rate of 40%(P=0.146).The survival analysis after PSM of the patients without suspected lymph node metastasis in the upper mediastinum based on preopreative examinations:88 cases through left approach with 5-year survival rate of 33%,another 88 cases through right approach with 5-year survival rate of 44%(P=0.239).Summary:For the middle and lower thoracic esophageal cancer patients whether or not who has suspected lymph node metastasis in the upper mediastinum based on preopreative examinations,the surgical treatment through right thoracic approach can achieve better overall survival than that through right approach.but no statistical significant difference in the long-term survival rate between two groups.Therefore,further prospective randomized clinical trials are still needed to verifythethe dispute on the approach selection.