title: Left thoracotomy for middle or lower thoracic esophageal carcinoma: still Sweet enough?
abstract: BACKGROUND
  Esophagectomy via left thoracotomy (the Sweet procedure) has long been the conventional route for resection of esophageal carcinoma, especially in China. However, this procedure is being increasingly critiqued, mainly regarding the lymphadenectomy. The objective of this study was to compare the Sweet procedure with the right upper mediastinal lymph node resection (MS) and Ivor-Lewis (IL) procedure in the treatment of middle or lower thoracic esophageal squamous cell carcinoma (OSCC-MLT) in terms of lymphadenectomy, postoperative complications, and long-term survival.
  
  
  METHODS
  A total of 336 OSCC-MLT patients underwent radical intent surgery (188 with MS and 148 with IL procedure) between January 2007 and September 2013 in our hospital. After propensity score matching, 129 patients from each procedure were included. The efficacy of lymph node dissection at each station was estimated by the index of estimated benefit from lymph node dissection (IEBLD).
  
  
  RESULTS
  IEBLD is relatively high in stations 2L, 2R, 8, 16 and 17. The metastasis rates and ratios were similar between the MS and IL procedures at each station. The MS procedure significantly outperformed the IL procedure with a shorter operating time (212vs. 317 min), shorter in-hospital stay (10.7vs. 15.3 days), and fewer postoperative complications (30.2%vs. 43.4%). However, the 5-year survival rates were not significantly different between the two procedures (46.9%vs. 44.0%).
  
  
  CONCLUSIONS
  The MS procedure of esophagectomy is not inferior to the IL procedure in efficiency, moreover the MS procedure is safer.
authors.affiliation: Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China; Department of Thoracic Surgery, Chongqing Cancer Institute, Chongqing 400030, China.
authors.forename: Zhi-Qiang
authors.initials: ZQ
authors.lastname: Wang
authors.affiliation: Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China.
authors.forename: Wen-Ping
authors.initials: WP
authors.lastname: Wang
authors.affiliation: Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Peng
authors.affiliation: Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China.
authors.forename: Yun-Cang
authors.initials: YC
authors.lastname: Wang
authors.affiliation: Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China.
authors.forename: Long-Qi
authors.initials: LQ
authors.lastname: Chen
keywords: Esophageal squamous cell carcinoma; lymph node; lymphadenectomy; sweet