| Summary: | Sujing Liu,1,2 Hui Zhu,1 Wanghu Li,3 Baijiang Zhang,4 Li Ma,5 Zhijun Guo,6 Yong Huang,3 Pingping Song,4 Jinming Yu,1 Hongbo Guo4 1Department of Radiation Oncology, Shandong Cancer Hospital and Institute, 2Shandong Academy of Medical Sciences, 3Department of Radiology, 4Department of Thoracic Surgery, 5Department of Nuclear Medicine, 6Department of Intensive Care Unit, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People’s Republic of China 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. Keywords: esophagectomy, surgical approach, survival, esophageal cancer, PET/CT
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