Qianwen Liu1,2, Junying Chen1,2, Jing Wen1,2, Hong Yang1,2, Yi Hu1,2, Kongjia Luo1,2, Zihui Tan1,2, Jianhua Fu1,2. 1. Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. 2. Guangdong Esophageal Cancer Institute, Guangzhou, China.
Abstract
BACKGROUND: the right- and left-approach open esophagectomies remain the general procedures among patients with operable thoracic esophageal squamous cell carcinoma (ESCC). The choice between the two approaches for elderly patients is controversial. METHODS: we performed a 1:1 propensity score matching (PSM) analysis to compare the impact of right- and left-approach esophagectomies on survival and perioperative complications of elderly ESCC patients. Patients aged over 70 receiving esophagectomy to treat the thoracic ESCC were retrospectively retrieved. RESULTS: a total of 276 patients were included in the study. Among them, 75 (27.2%) patients received right-approach esophagectomy. After match, 114 patients (57 pairs) undertook right or left-approach esophagectomy displayed no difference among clinicopathological characteristics. Both the overall survival (54.6% vs. 32.6%, P=0.036) and disease-free survival (52.7% vs. 20.2%, P=0.021) were significant better in right-approach group, along with better lymph node resection, and lower incidence of recurrence. However, increased incidences of postoperative pneumonia (P=0.040), respiratory failure (P=0.028), and sub-clinical anastomotic leak (P=0.032) were found in right-approach group as well, although the perioperative mortality was similar between groups. CONCLUSIONS: Right-approach esophagectomy should be accepted as a preferential surgical approach for elderly patients with ESCC.
BACKGROUND: the right- and left-approach open esophagectomies remain the general procedures among patients with operable thoracic esophageal squamous cell carcinoma (ESCC). The choice between the two approaches for elderly patients is controversial. METHODS: we performed a 1:1 propensity score matching (PSM) analysis to compare the impact of right- and left-approach esophagectomies on survival and perioperative complications of elderly ESCC patients. Patients aged over 70 receiving esophagectomy to treat the thoracic ESCC were retrospectively retrieved. RESULTS: a total of 276 patients were included in the study. Among them, 75 (27.2%) patients received right-approach esophagectomy. After match, 114 patients (57 pairs) undertook right or left-approach esophagectomy displayed no difference among clinicopathological characteristics. Both the overall survival (54.6% vs. 32.6%, P=0.036) and disease-free survival (52.7% vs. 20.2%, P=0.021) were significant better in right-approach group, along with better lymph node resection, and lower incidence of recurrence. However, increased incidences of postoperative pneumonia (P=0.040), respiratory failure (P=0.028), and sub-clinical anastomotic leak (P=0.032) were found in right-approach group as well, although the perioperative mortality was similar between groups. CONCLUSIONS: Right-approach esophagectomy should be accepted as a preferential surgical approach for elderly patients with ESCC.
Authors: S Kinugasa; M Tachibana; H Yoshimura; D K Dhar; M Shibakita; S Ohno; H Kubota; R Masunaga; N Nagasue Journal: Ann Thorac Surg Date: 2001-02 Impact factor: 4.330
Authors: Surya S A Y Biere; Mark I van Berge Henegouwen; Kirsten W Maas; Luigi Bonavina; Camiel Rosman; Josep Roig Garcia; Suzanne S Gisbertz; Jean H G Klinkenbijl; Markus W Hollmann; Elly S M de Lange; H Jaap Bonjer; Donald L van der Peet; Miguel A Cuesta Journal: Lancet Date: 2012-05-01 Impact factor: 79.321
Authors: T W Rice; V W Rusch; C Apperson-Hansen; M S Allen; L-Q Chen; J G Hunter; K A Kesler; S Law; T E M R Lerut; C E Reed; J A Salo; W J Scott; S G Swisher; T J Watson; E H Blackstone Journal: Dis Esophagus Date: 2009 Impact factor: 3.429