# Comparison of right- and left-approach esophagectomy for esophageal cancer: a meta-analysis

## TL;DR

This study compares two surgical approaches for esophageal cancer and finds that the right approach removes more lymph nodes but increases certain risks.

## Contribution

A meta-analysis comparing outcomes of left and right thoracic approaches for esophagectomy in esophageal cancer patients.

## Key findings

- The right thoracic approach results in longer surgical duration and more lymph nodes removed.
- The right approach increases the risk of anastomotic fistula, wound infection, and pulmonary complications.
- No significant differences were found in chylothorax, hospital stay, or survival rates between the two approaches.

## Abstract

This study aims to compare the effects of left and right thoracic approaches on patients undergoing esophagectomy.

A search was conducted across PubMed, Embase, Cochrane, and Web of Science for randomized controlled trials, cohort studies, and non-randomized trials that evaluated the effects of the two approaches on patients with esophageal cancer up to March 19, 2025. Two reviewers independently screened the retrieved articles, extracted relevant data, and appraised the risk of bias. A meta-analysis was performed using Stata statistical software.

A total of 21 studies were included. Compared with the left thoracic approach, the right approach had a longer surgical duration (mean difference [MD] = 77.51, 95% confidence interval [CI]: 53.19–101.84, P < 0.05), a higher number of lymph nodes removed (MD = 3.00, 95% CI: 0.30–5.69, P < 0.05), and a higher risk of anastomotic fistula (MD = 2.07, 95% CI: 1.49–2.88, P < 0.05), wound infection (MD = 1.68, 95% CI: 1.04–2.73, P < 0.05) and pulmonary complications (risk ratio = 1.39, 95% CI: 1.15–1.68, P < 0.01). There were no significant differences in the risk of chylothorax, postoperative hospital stays, long-term disease-free survival, or overall survival.

Esophagectomy through the right thoracic approach achieves more thorough lymph node dissection, but it is associated with an increased risk of longer surgical duration, anastomotic fistula, wound infection, and pulmonary complications.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251026319, identifier CRD420251026319.