Potential impact of 18FDG-PET/CT on surgical approach for operable squamous cell cancer of middle-to-lower esophagus

摘要

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. Conclusion: For patients with middle-to-lower EC, surgical approaches directed by PET/CT may increase the likelihood of complete resection and affect DFS.