title: Potential impact of (18)FDG-PET/CT on surgical approach for operable squamous cell cancer of middle-to-lower esophagus.
abstract: BACKGROUND
  Fluorodeoxyglucose-positron emission tomography (PET)/computed tomography (CT) is reported to have a significant advantage over CT for staging esophageal cancer (EC). However, whether PET/CT may play a useful role in guiding surgical approach remains undetermined.
  
  
  METHODS
  Patients with potentially resectable squamous cell EC were randomized into either PET/CT group or CT group. The surgical data and survival outcomes were compared.
  
  
  RESULTS
  Compared to the CT group, the right-sided approach was more frequently used (42.6% versus 25.5%, P=0.065) in the PET/CT group in order to allow surgical access to radiographically suspicious lymph nodes inaccessible from the left, thus enabling the removal of more involved lymph nodes (2.83 versus 1.76; P=0.039) as well as their stations (1.65 versus 1.08; P=0.042). Although the overall survival between the two groups was similar, the PET/CT group had a longer disease-free survival (DFS) than the CT group (27.1 months versus 18.9 months; P=0.019), especially in the subgroup of node-positive patients (22.5 months versus 13.5 months; P=0.02). Preoperative imaging arm was the only prognostic factor found to independently influence DFS.
  
  
  CONCLUSIONS
  For patients with middle-to-lower EC, surgical approaches directed by PET/CT may increase the likelihood of complete resection and affect DFS.
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China; Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China.
authors.forename: Sujing
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Radiology, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China.
authors.forename: Wanghu
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Thoracic Surgery, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China.
authors.forename: Baijiang
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China.
authors.forename: Li
authors.initials: L
authors.lastname: Ma
authors.affiliation: Department of Intensive Care Unit, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China.
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Guo
authors.affiliation: Department of Radiology, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Thoracic Surgery, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China.
authors.forename: Pingping
authors.initials: P
authors.lastname: Song
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China.
authors.forename: Jinming
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Thoracic Surgery, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China.
authors.forename: Hongbo
authors.initials: H
authors.lastname: Guo
keywords: PET/CT; esophageal cancer; esophagectomy; surgical approach; survival