Right vs Left Thoracic Approach for Esophageal Adenocarcinoma

Surgical approach selection may affect short- and long-term outcomes of esophageal cancer patients. Controversies exist regarding the optimal surgical approach for esophageal adenocarcinoma. High-level evidence of right versus left thoracic approach for esophageal adenocarcinoma has not been obtained until the present. For esophageal adenocarcinoma with suspected metastatic lymph nodes in the upper mediastinum, referring to the evidence from esophageal squamous cell carcinoma, esophagectomy through right thoracic approach with extended two-field lymph node dissection including the upper mediastinal lymph nodes is strongly recommended as an optimal approach to achieve better survival. However, for esophageal adenocarcinoma without suspected metastatic lymph node in the upper mediastinum, either the right or left thoracic approach can be selected based on surgeon’s experience and preference as well as patients’ situation due to similar outcomes.