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Left compared with right thoracic approach thoracotomy in esophageal cancer: a retrospective cohort study

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Abstract

Background

Esophagectomy is regarded as one of the optimal treatments for resectable esophageal cancer. However, the impact of surgical approach on the long-term prognosis of esophageal cancer remains controversial. This study attempted to compare the long-term survival outcomes of patients receiving left and right thoracic esophagectomy for esophageal cancer.

Methods

A total of 985 patients underwent esophagectomy (including 453 left and 532 right thoracic approach) for esophageal cancer in Henan Cancer Hospital from January 2015 to December 2016 were enrolled. Their 5 year overall survival (OS) and disease-free survival (DFS) were retrospectively collected. Cox regression was performed to compare OS and DFS in patients who underwent left and right thoracic esophagectomy. Propensity score matching (PSM) analysis was used to balance confounding factors.

Results

The 5 year OS rates were 60.21% in the left and 51.60% in the right thoracic esophagectomy, respectively (P = 0.67). The 5 year DFS rates were 56.73% in the left and 47.93% and in the right thoracic esophagectomy, respectively (P = 0.36). Cox regression analysis showed there was no significant difference in long-term survival between patients with left and right surgical access (OS: HR = 0.95, 95% CI 0.77–1.18; DFS: HR = 0.91, 95% CI 0.74–1.12). In the cohort of patients obtained by PSM, Cox regression analysis yielded the similar results.

Conclusion

For patients with resectable esophageal cancer, the surgical treatment through left thoracic approach can achieve the same long-term survival outcomes as the right thoracic approach.

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Data availability

The data underlying this article were provided by the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital under licence. Data will be shared on request to the corresponding author with permission of the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital.

Abbreviations

CI:

Confidence interval

DFS:

Disease-free survival

HR:

Hazard ratios

M:

Mean

OS:

Overall survival

Pathological N stage:

Pathological lymph-node stage

PSM:

Propensity score matching

Pathological T stage:

Pathological tumor stage

SD:

Standardized deviation

SMD:

Standardized mean difference

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Acknowledgements

The authors sincerely acknowledge the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital for their support. We also gratefully thank all the research participants who gave their valuable time in this project.

Funding

The authors declare that no funds, grants, or other supports were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China

    Yongli Yang, Xin Xin, Xuezhong Shi, Chaojun Yang, Jingwen Fan & Xiaocan Jia

  2. Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China

    Peinan Chen

  3. Department of Medical Record, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China

    Yi Zhang

Authors
  1. Yongli Yang
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  2. Xin Xin
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  4. Xuezhong Shi
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  5. Chaojun Yang
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  7. Yi Zhang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by XJ, YY, XX, PC, and YZ. The first draft of the manuscript was written by YY and XX. The manuscript was reviewed and revised by YY, XJ, XS, CY, and JF, and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xiaocan Jia.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The study was performed following the Declaration of Helsinki set of principles. All data collection and analysis in this study were reviewed and approved by the Ethics Committee of Zhengzhou University (ZZUIRB2022-99). Informed written consent was obtained from each patient.

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Yang, Y., Xin, X., Chen, P. et al. Left compared with right thoracic approach thoracotomy in esophageal cancer: a retrospective cohort study. J Cancer Res Clin Oncol 149, 8289–8296 (2023). https://doi.org/10.1007/s00432-023-04765-4

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  • DOI: https://doi.org/10.1007/s00432-023-04765-4

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