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The prognostic significance of tumor laterality in patients with esophageal squamous cell carcinoma


  • Conflict of Interests: The authors declared no conflict of interest and no financial support for this study.

  • This study was presented at the 12th World Congress of the International Society for Disease of the Esophagus, Kagoshima, Japan, 2010.



It has been shown that part of the lymph fluid from the right/dorsal side of the esophagus drains directly into the thoracic duct, whereas the lymph fluid from the left/ventral side has to pass through lymph nodes before entering the duct. We hypothesized that patients with right/dorsal tumors have a poorer prognosis than those with left/ventral tumors because cancer cells from the right/dorsal quadrant may easily enter the systemic circulation.


A total of 77 patients with pT1b- or pT2-staged cancers treated by esophagectomy without neoadjuvant treatment were enrolled in this study. Tumor laterality was determined endoscopically.


The tumor location was right/dorsal in 45 patients and left/ventral in 32. The right/dorsal group had a lower lymph node stage (pN, P = 0.043) and shorter disease-free survival (P = 0.027). Multivariate analysis demonstrated that tumor laterality [hazard ratio (HR): 0.052, 95% confidence interval (CI): 0.007–0.37, P = 0.003], pN (HR: 3.8, 95% CI: 1.7–9.1, P = 0.001), and tumor size (HR: 1.02, 95% CI: 1–1.04, P = 0.02) were independent prognostic factors.


This is the first study to demonstrate a relationship between tumor laterality and prognosis in patients with esophageal squamous cell carcinoma. These findings need to be validated in a prospective large study. J. Surg. Oncol. 2012; 105:66–70. © 2011 Wiley Periodicals, Inc.

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