Compare Of Treatment Outcomes After Two Different Surgical Approaches For Operable Middle Thoracic Esophageal Squamous Cell Carcinoma

BackgroundIn china and some other asia countries, esophageal squamous cell carcinoma(ESCC) continued to be the most common maynlignance of esophagus,and it was frequently located in the middle thoracic esophagus.Surgery was primarily taken for operable middle thoracic ESCC.the most commonly used surgical approaches in China included the left transthoracic procedure and the right transthoracic procedure. the left transthoracic procedure included the left transthoracic esophagectomy with gastroesophageal anastomosis upon the aortic arch and the left transthoracic esophagectomy with gastroesophageal anastomosis in the left neck. the right transthoracic procedure included the Ivor-Lewis approach and the cerevical-thoracoabdominal approach(McKeown approach).Object:In order to identify which approach is more proper for excision of middle thoracic ESCC, we conducted this study to compare the treatment efficency of two classical routes, namely the Ivor-Lewis approach and the left transthoracic esophagectomy with gastroesophageal anastomosis upon the aortic arch. We hoped to provide information for doctors facing the above choices.Methods:We enrolled107patients with middle thoracic ESCC who underwent curative esophagectomy in the Department of Thoracic Surgery, Provincial Hospital Affiliated to Shandong University, Shandong University from January2008to January2010. All patients were divided into two cohorts:the left transthoracic cohort and the Ivor-Lewis cohort.OS and five year survival rate were analyzed by Cox proportional hazards regression and Kaplan-Meier curves.The Mann-Whitney U-test was utilized to compare continuous variables.Chi-Square or Fisher exact test was used to compare the differences of post-operative complications, lymph nodes resection, post-operative drainage, post-operative hospital stay between the two cohorts.Results:We enrolled86males and21females in our analysis; the median age was58years (range,41to74years). There were42patients who underwent the left transthoracic esophagectomy and65patients who underwent the Ivor-Lewis esophagectomy.The5year OS rate was comparable between the left transthoracic cohort and the Ivor-Lewis cohort (left:53.7%; right:43.3%, P=0.185).Patients in the left transthoracic cohort tended to obtain similar cumulative survival compared with the Ivor-Lewis cohort (P=0.315).The3year Recurrence Free Survival RFS was higher in the left transthoracic cohort (Left:61.9%, Right:52.9%P=0.411).Patients in the Ivor-Lewis cohort were with significantly higher blood loss volume (P=0.007) and longer operation time (P=0.042). T status(P=0.001), N status(P=0.007) as well as metastatic lymph node ratio (MLR, P=0.040) were shown as independent prognostic risk factors by COX regression analysis.Our data also revealed that patients with MLR less than0.2had better OS than the patients who not (Log Rank test P=0.015.Other factors, namely the number of dissected LNs (P=0.065), first day chest drainage volume (P=0.057), total chest drainage volume (P=0.241) and time (P=0.546), Positive lymph nodes (P=0.188) showed no significant difference between these two cohorts. The complication rate was generally comparable between the two cohorts. There were more anastomotic fistula (P=0.264), pulmonary infection (P=0.772) and heart failure (P=0.630) reported in the Ivor-Lewis cohort, although the difference was not significant.Conclusion:Both the Ivor-Lewis approach and the left transthoracic approach were optional surgical routes for operable middle thoracic ESCC.