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Esophageal cancer is a malignant tumor with a high incidence in China. At pesent, advanced esophageal cancer patients are still frequently encountered. The primary treatment for resectable advanced esophageal cancer is surgery-based multimodality therapy, including preoperative neoadjuvant therapy, such as chemotherapy, chemoradiotherapy or chemotherapy plus immunotherapy, followed by radical esophagectomy with thoraco-abdominal two-field or cervico-thoraco-abdominal three-field lymphadenectomy via minimally invasive approach or thoracotomy. In addition, adjuvant chemotherapy, radiotherapy, or chemoradiotherapy, or immunotherapy may also be administered if suggested by postoperative pathological results. Although the treatment outcome of esophageal cancer has improved significantly in China, many clinical issues remain controversial. In this article, we summarize the current hotspots and important issues of esophageal cancer in China, including prevention and early diagnosis, treatment selection for early esophageal cancer, surgical approach selection, lymphadenectomy method, preoperative neoadjuvant therapy, postoperative adjuvant therapy, and nutritional support treatment.
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Humans , Esophageal Neoplasms/surgery , Combined Modality Therapy , Neoadjuvant Therapy/methods , Chemoradiotherapy , Chemotherapy, Adjuvant , Esophagectomy/methodsABSTRACT
@#Resection is one of the most important treatments for esophageal squamous cell carcinoma, and routine postoperative follow-up is an effective method for early detection and treatment of recurrent metastases, which can improve patients' quality of life and prognosis. This consensus aims to provide a reference for colleagues responsible for postoperative follow-up of esophageal squamous cell carcinoma patients in China, and further improve the standardization of the diagnosis and treatment of esophageal squamous cell carcinoma.
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Resectable non-small cell lung cancer (NSCLC) is currently considered as a potentially curable disease. Surgery is still the main treatment mode for resectable NSCLC, but quite a few patients will have local recurrence and distant metastasis after surgery. Therefore, preoperative and postoperative adjuvant therapy may be necessary in order to improve the long term outcome. Immunocheckpoint inhibitor has been demonstrated clinically to be effective andapproved as first- or second-line treatment agent in metastatic NSCLC or partially locally advanced NSCLC. The remarkable efficacy of immunotherapy for advanced lung cancer has attracted more and more attention from the researchers to the role of immunotherapy as neoadjuvent therapy in resectable non-small cell lung cancer. This article systematically reviewed the clinical trials of neoadjuvant immunotherapy for resectable NSCLC before surgery.
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Objective@#The role of planned neoadjuvant radiotherapy or chemoradiotherapy in the non-radical resection of esophageal squamous cell carcinoma was unclear. The study aimed to evaluate their therapeutic effect and analyze the prognostic factors.@*Methods@#We retrospectively analyzed the clinical data of locally advanced esophageal squamous cell carcinoma who received neoadjuvant radio therapy (33 patients) and concurrent chemoradiotherapy (119 patients) from January 2004 to December 2016 in our single-institution database.The survival rates were calculated by Kaplan-Meier method. The prognostic factors were analyzed by using Log rank test and Cox proportional hazards model.@*Results@#The median follow-up was 29.8 months. One hundred and one patients survived more than 3 years. The rates of overall survival (OS) and disease-free survival (DFS) at 3 years were 63.9% and 55.6%, respectively.The rates of complete, partial and minimal pathological response of the primary tumor were 50.3%, 38.4%, 11.3%, the corresponding 3-year OS were 75.5%, 57.4%, 27.3% (P<0.001) and 3-year DFS were 72.0%, 44.7%, 17.6% (P<0.001), respectively.The postoperative lymph node metastasis rate was 27.0%. The 3-year OS and DFS of the lymph node positive group was 45.6% and 32.8%, significantly lower than 70.8% and 63.7% of the negative group (both P<0.001). The 3-year OS and DFS of pathologic stage Ⅰ, Ⅱ, ⅢA, ⅢB and Ⅵ A were 76.2%, 57.4%, 64.7%, 35.0%, 33.3% (P<0.001) and 70.1%, 49.3%, 41.2%, 22.1%, 33.3% (P<0.001), respectively.The operation-related mortality was 3.3%. Multivariate analysis showed that chest pain, postoperative respiratory failure, pathological differentiation, more than 15 lymph node dissection and ypTNM stage were the independent prognostic factors of OS (P<0.05 for all).@*Conclusions@#The planned neoadjuvant radiotherapy or chemoradiotherapy for the non-radical resection of advanced esophageal squamous cell carcinoma could result in favorable survival. The chest pain, postoperative respiratory failure, pathological differentiation, the number of lymph node resection and ypTNM stage are the independent prognostic factors of the prognosis of these patients.
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Esophageal cancer is the sixth leading cause of cancer-related death worldwide due to its high malignancy and poor prognosis. In recent decades, the applications of new technologies, devices and neoadjuvant therapy lead to the great progress in the diagnosis and treatment of esophageal cancer. However, the five-year survival rate of esophageal cancer remains unsatisfied. Clinical and pathological factors such as the primary tumor (T), regional lymph nodes (N) and distant metastasis (M) and the longitudinal margins of esophageal lesions, lymphatic invasion, peripheral nerve invasion have been identified as important predictors of the prognosis of esophageal cancer. However, the effect of circumferential resection margin on the prognosis evaluation of esophageal cancer is still controversial, and no definite identification of circumferential resection margin of esophageal cancer has been acknowledged worldwide. Therefore, the studies of circumferential resection margin involvement in predicting the prognosis of esophageal cancer are reviewed.
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Three-field lymph node dissection improved the postoperative survival and accuracy of pathological staging of patients with esophageal cancer, and reduced the postoperative local recurrence rate of esophageal cancer patients. However, this surgical procedure enlarged the trauma, cansed more complications, prolonged postoperative hospital stays, and seriously impaired the postoperative adjuvant therapy. Therefore, selection of patients who are suitable for three-field lymph node dissection is extremely important. The special anatomical location of recurrent laryngeal nerve lymph nodes is potentially suitable for it to serve as sentinel lymph node for the evacuation of cervical lymph nodes dissection in esophageal cancer. The guiding value of recurrent laryngeal nerve lymph node metastasis in cervical lymph node dissection of thoracic esophageal cancer is reviewed.
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Esophageal cancer is one of the most prevalent cancers in China. Lymph node metastasis is one of the most important prognostic factors and severely affect the long-term survival after surgical treatment. Therefore, systemic two-field lymph node dissection including thoracic and abdominal draining nodes of the esophagus during surgery is essential in order to improve the long-term survival for the patients with thoracic esophageal cancer, and it is also the basis for precise staging and postoperative adjuvant treatment regimen- making. As reported in the literature, lymph node metastases along bilateral recurrent laryngeal nerve was the highest, therefore, the lymph node dissection along bilateral recurrent laryngeal nerve is the most important manipulation during esophagectomies, however, it is also the most technically difficult procedure during operation. It usually results in postoperative complications especially the respiratory complications due to paralysis of recurrent laryngeal nerves caused by lymph node dissection. Therefore, the gain and loss of lymph node dissection along bilateral recurrent laryngeal nerve has been a disputed and entangle topic for thoracic surgeons, and the purpose of this paper is to summarize author′s experience and the key technology to prevent the associated complications in lymph node dissection along recurrent laryngeal nerve during esophagectomies for the patients with thoracic esophageal cancer.
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T cells and T cell receptors (TCRs) play pivotal roles in adaptive immune responses against tumors. The development of next-generation sequencing technologies has enabled the analysis of the TCRβ repertoire usage. Given the scarce investigations on the TCR repertoire in lung cancer tissues, in this study, we analyzed TCRβ repertoires in lung cancer tissues and the matched distant non-tumor lung tissues (normal lung tissues) from 15 lung cancer patients. Based on our results, the general distribution of T cell clones was similar between cancer tissues and normal lung tissues; however, the proportion of highly expanded clones was significantly higher in normal lung tissues than in cancer tissues (0.021% ± 0.002% vs. 0.016% ± 0.001%, P = 0.0054, Wilcoxon signed rank test). In addition, a significantly higher TCR diversity was observed in cancer tissues than in normal lung tissues (431.37 ± 305.96 vs. 166.20 ± 101.58, P = 0.0075, Mann-Whitney U test). Moreover, younger patients had a significantly higher TCR diversity than older patients (640.7 ± 295.3 vs. 291.8 ± 233.6, P = 0.036, Mann-Whitney U test), and the higher TCR diversity in tumors was significantly associated with worse cancer outcomes. Thus, we provided a comprehensive comparison of the TCR repertoires between cancer tissues and matched normal lung tissues and demonstrated the presence of distinct T cell immune microenvironments in lung cancer patients.
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Objective@#To study the impact of the advance of the times and technological progress on the surgical treatment of lung cancer.@*Methods@#The data of patients with non-small cell lung cancer treated by thoracic surgery at Cancer Hospital of Chinese Academy of Medical Sciences from 2005 to 2015 were retrospectively analyzed. The population distribution, operation methods and treatment results were analyzed retrospectively.@*Results@#510 patients (in 2005) and 1 235 (in 2015) non-small cell lung cancer patients were included in this study. The proportions of male patients (79.0% vs. 55.8%), smoking (52.9% vs. 30.1%), squamous cell carcinoma (50.2% vs. 22.4%) and video-assisted thoracoscopic surgery (VATS) (0 vs. 61.1%), stage Ⅰ (15.2% vs. 36.8%), the number of lymph node dissection (21.8 vs. 16.6), intraoperative blood transfusion rate (9.6% vs. 1.9%), palliative resection rate (7.5% vs. 2.0%), the average length of stay (10.8 d vs. 7.6 d) were significantly changed. There was no significant difference in the average age of patients and operation time.@*Conclusion@#There was a significant change in the distribution of population and surgical techniques in patients undergoing lung cancer surgery in last ten years.
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Esophageal cancer is one of the most common malignant digestive system cancers in China, which has high incidence and mortality. Nowadays, surgery remains the most important part of the comprehensive treatments. Conventional open esophagectomies are highly traumatic with high morbidity, while minimally invasive esophagectomy has been increasingly used with the development of surgical instruments and techniques in recent years. Compared with conventional open esophagectomy(OE), what are the advantages of minimally invasive esophagectomy (MIE) and which is preferable? This review briefly introduces the developing history of MIE and common procedures. Then we review large amounts of relevant literatures, comparing MIE with OE in perioperative rehabilitation, lymph node dissection and long-term survival. Results showed that compared with OE, MIE had less blood loss during operation, less postoperative pulmonary complications, shorter hospital stay and ICU time, meanwhile, there were no significant differences in the incidence of anastomotic leak, perioperative mortality, R0 resection and total number of resected lymph nodes. However, there are still no clear results of comparisons on operative time, recurrent laryngeal nerve palsy, and long-term survival, thus, more supportive evidences from prospective large-sample observation studies or randomized controlled trials are still needed. Furthermore, this review also presents the application and the progress of robotic-assisted MIE(RAMIE), demonstrates the current use of robotic technology during esophagectomies, meanwhile forecasts the future advancements of RAMIE. For the moment, the limitations of RAMIE to be widely used mainly include the cost and controlling of surgical indications, and we hope these can be settled in the coming years.
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Superior sulcus tumor of the lung is a bronchogenic tumor occurred in the apex of the upper lobe of the lung and is a unique clinical subtype of non-small cell lung cancer (NSCLC), which account for less than 5% of all bronchogenic carcinomas. It often involves the first rib, brachial plexus, subclavian vessels, sympathetic chain, stellate ganglion or vertebra. A lot of progress has been achieved in the treatment of superior sulcus tumor over the past decades. Several clinical trials reported in recent years have confirmed that concurrent chemoradiotherapy followed by surgical resection can improve the rate of complete resection, local control and pathological remission of the tumor, and prolong the total-survival time. It has become the most effective treatment mode for the superior sulcus tumor, and recommended as a standard treatment mode for superior sulcus tumor by National Comprehensive Cancer Network (NCCN) and American College of Chest Physicians (ACCP) guidelines. This article reviews relevant literatures at home and abroad, and briefly introduces the advances in surgical treatment and comprehensive treatment of superior sulcus tumor. .
Subject(s)
Humans , Combined Modality Therapy , Lung Neoplasms , Drug Therapy , General Surgery , Therapeutics , Molecular Targeted Therapy , Ribs , Treatment OutcomeABSTRACT
BACKGROUND@#Surgeons are the direct decision-makers and performers in the surgical treatment of patients with lung cancer. Whether the differences among doctors affect the survival of patients is unclear. This study analyzed the five-year survival rates of different thoracic surgeries in patients undergoing surgery to assess the physician's impact and impact.@*METHODS@#A retrospective analysis of five years between 2002-2007 in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, for surgical treatment of lung cancer patients. According to different surgeons grouping doctors to compare the basic information of patients, surgical methods, short-term results and long-term survival differences.@*RESULTS@#A total of 712 patients treated by 11 experienced thoracic surgeons were included in this study. The patients have nosignificant difference with gender, age, smoking, pathological type between groups. There were significant differences in clinical staging, surgery type, operation time, blood transfusion rate, number of lymph node dissection, palliative resection rate, postoperative complications and perioperative mortality. There was a significant difference in five-year survival rates among patients treated by different doctors. This difference can be seen in all clinical stage analyzes with consistency. In the multivariate analysis, it was suggested that surgeon was an independent factor influencing the prognosis of patients.@*CONCLUSIONS@#Thoracic surgeon has a significant effect on the therapeutic effect of lung cancer patients.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Lung Neoplasms , General Surgery , Multivariate Analysis , Postoperative Complications , Retrospective Studies , Surgeons , Survival Analysis , Thoracic Surgery , Thoracic Surgical ProceduresABSTRACT
Esophageal squamous cancer is a malignancy with high incidence and mortality. Surgery currently remains the most important part of the comprehensive treatments. The number of metastatic lymph node has great influence on the prognosis of esophageal cancer, so thorough lymphadenectomy also becomes a key factor. Meanwhile, the choice of lymphadenectomy procedure during surgery has always been controversial. In current article, we summarized the pattern in lymph node metastasis in thoracic esophageal squamous cell carcinoma by analyzing relevant literatures, and discovered that the longitudinal lymphatic network of the submucosa and the horizontal lymphatic pathways of the muscularis propria are the anatomical foundation of the lymph node metastasis of esophageal cancer. Then, we evaluated the impact of lymph node metastasis on the prognosis in terms of number of metastatic lymph node, distant metastasis, positive lymph node ratio, solitary metastasis, micrometastasis and extracapsular lymph node involvement. During surgery, should we choose two-field lymphadenectomy (2-FL) or three-field lymphadenectomy (3-FL)? The clinical efficacy was compared between 2-FL and 3-FL in this paper. The results showed that compared with patients who underwent 2-FL, those who underwent 3-FL had significantly higher 5-year survival rate, significantly longer operative time, and more dissected lymph nodes, while blood loss during surgery was not significantly different. As for complication, some studies indicated that patients after 3-FL had a significantly higher risk of anastomotic leakage, recurrent laryngeal nerve paralysis, and tracheal ischemia, while no significant differences in pulmonary infection and chylothorax were found. At last, we introduced the application of sentinel lymph node technique and relevant research evidence of recurrent laryngeal nerve lymph node as predictive markers for cervical lymph node metastasis.
Subject(s)
Humans , Carcinoma, Squamous Cell , General Surgery , Esophageal Neoplasms , General Surgery , Esophagectomy , Lymph Node Excision , Lymph Nodes , Neoplasm Staging , Retrospective StudiesABSTRACT
Objective@#To analyze risk factors of anastomotic leakage after McKeown'sesophagectomy.@*Methods@#The clinical data of 635 esophageal cancer patients, who underwent McKeown's esophagectomy at Cancer Hospital of Chinese Academy of Medical Sciences from January 2012 to December 2015, were retrospectively analyzed. The risk factors of cervical anastomotic leakage were identified through analysis of medical history, surgical procedure, tumor characteristics and vascular calcification.@*Results@#Among all the 635 patients, anastomotic leakage occurred in 111 (17.5%)patients. Univariate analysis showed that the American Society of Anesthesiologists (ASA) risk class, prior thoracic surgery, upper digestive tract ulcer, COPD, hypertension, peripheral vascular disease, renal insufficiency, FEV1% predicted, DLCO% predicted, duration of surgery and calcification of descending aorta, celiac trunk and left postceliac arteries were associated with a statistically significant increase in risk of cervical anastomotic leakage (P<0.05 for all). Logistic regression analysis showed that ASA risk class, peripheral vascular disease, renal insufficiency and calcification of descending aorta and celiac trunk were independent risk factors of cervical anastomotic leakage after McKeown's esophagectomy (P<0.05 for all).@*Conclusions@#ASA risk class, peripheral vascular disease, renal insufficiency, calcification of descending aorta and celiac trunk are independent risk factors of cervical esophageal anastomotic leakage after McKeown's esophagectomy.
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Objective@#To evaluate the feasibility and efficacy of biweekly paclitaxel and platinum chemotherapy followed by surgery for esophageal squamous cell carcinoma.@*Methods@#We retrospectively analyzed the clinicopathological data of 20 patients with esophageal squamous cell carcinoma treated in our hospital between January 2012 and March 2016. All patients received biweekly paclitaxel and platinum chemotherapy followed by surgery.@*Results@#20 cases received preoperative chemotherapy for 3-8 cycles with an average of 4 cycles. The main chemotherapy-related adverse events were bone marrow suppression (18/20, 90.0%), followed by vomiting and nausea (10/20, 50.0%). Five patients (25.0%) had grade 4 neutropenia and all toxicities were torlerable and manageable. After chemotherapy, all patients received surgery. The histological responses in the primary tumors were grade 1 in 13 (65.0%) patients, grade 2 in 7 (35.0%) patients, and grade 3 in 0 (0%) patient. None had disease progression. Downstaging of T-stage was observed in 5 cases (25.0%) after chemotherapy. Among them, 4 cases were with moderate histologicl responses and one case with mild histological response. The incidence of postoperative complications was 25.0%(5/20), and the complications were improved following symptomatic treatments. There was no treatment-related death.@*Conclusions@#Biweekly paclitaxel and platinum chemotherapy followed by surgery for esophageal squamous cell carcinoma is safe and effective. Further randomized clinical trial should be conducted to assess the value of this therapeutic regimen in the preoperative chemotherapy for esophageal cancer.
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[ Abstract] Objective To investigate the clinical efficacy of preoperative three-dimensional radiotherapy (3DRT) with or without concurrent chemotherapy for esophageal carcinoma.Methods We retrospectively analyzed 103 esophageal carcinoma patients who received preoperative 3DRT with or without concurrent chemotherapy from 2004 to 2014 in Cancer Hospital CAMS.The median radiation dose was 40 Gy, and the TP or PF regimen was adopted for concurrent chemotherapy if needed.The overall survival (OS) and disease-free survival ( DFS) were calculated by the Kaplan-Meier method, and the survival difference and univariate prognostic analyses were performed by the log-rank test.The Cox proportional hazards model was used for multivariate prognostic analysis.Results The number of patients followed at 3-years was 54.The 3-year OS and DFS rates were 61.1% and 54.9%, respectively, for all patients.There were no significant differences between the 3DRT and concurrent chemoradiotherapy (CCRT) groups as to OS (P=0.876) and DFS (P=0.521).The rates of complete, partial, and minimal pathologic responses of the primary tumor were 48.0%, 40.2%, and 11.8%, respectively.There were significant differences in OS and DFS between the complete, partial, and minimal pathologic response groups (P=0.037 and 0.003). No significant difference in pathologic response rate was found between the 3DRT and CCRT groups (P=0.953).The lymph node metastasis rate was 26.5%, and this rate for the complete, partial, and minimal pathologic response groups was 14%, 30%, and 67%, respectively, with a significant difference between the three groups (P=0.001).The OS and DFS were significantly higher in patients without lymph node metastasis than in those with lymph node metastasis (P=0.034 and 0.020).The surgery-related mortality was 7.8% in all patients.Compared with the 3DRT group, the CCRT group had significantly higher incidence rates of leukopenia (P=0.002), neutropenia (P=0.023), radiation esophagitis (P=0.008), and radiation esophagitis ( P=0.023).Pathologic response of the primary tumor and weight loss before treatment were independent prognostic factors for OS and DFS (P=0.030,0.024 and P=0.003,0.042). Conclusions Preoperative 3DRT alone or with concurrent chemotherapy can result in a relatively high complete pathologic response rate, hence increasing the survival rate.Further randomized clinical trials are needed to confirm whether preoperative CCRT is better than 3DRT in improving survival without increasing the incidence of adverse reactions.
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Esophageal cancer is one of the most prevalent carcinoma with an incidence ranking at the fifth and the mortality at the fourth among all the carcinomas in China. Up to now, surgery-based multi-modality treatment is still the most effective treatment for esophageal carcinoma. The surgical approaches for esophageal cancer include left and right thoracic approaches. Esophagectomy through left thoracotomy is the earliest approach applied for esophageal cancer in China, and now is still used frequently for esophageal cancer in northern China. However, left thoracic approach is insufficient in the lymph node dissection for superior mediastinum and abdomen, especially for the tracheoesophageal groove and para-recurrent laryngeal nerve nodes. On the contrary, right thoracic approach can achieve complete thoracic and abdominal field(two-field) lymph node dissection, especially the tracheoesophageal groove and para-recurrent laryngeal nerve nodes, which may eventually improve the survival of the patients with esophageal cancer. This article summarizes the results of lymph node dissection and prognosis based on published literatures through left thoracic approach versus through right thoracic approach for esophageal cancer, comments on recent controversies and consensus: for resectable thoracic esophageal carcinoma, resection of thoracic esophageal carcinoma with 2-field or 3-field lymph node dissection through right thoracic approach should be recommended as the major treatment mode, but this consensus was made based on retrospective studies, and the evidence is only level III(, therefore, prospective randomized studies with larger sample size are warranted. The selection of surgical approach for the lower thoracic esophageal cancer patients without upper mediastinal lymph node enlargement is also the direction of future clinical trials.
Subject(s)
Humans , China , Consensus , Dissent and Disputes , Esophageal Neoplasms , General Surgery , Esophagectomy , Methods , Lymph Node Excision , Methods , Reference Standards , Lymph Nodes , Prognosis , Retrospective Studies , Thoracic Neoplasms , General Surgery , Thoracic Surgical Procedures , Methods , Treatment OutcomeABSTRACT
According to the different surgical approaches and its corresponding lymph node dissection modes, surgical treatment for esophageal cancer can be divided into different surgical treatment modes. Currently in China, the surgical treatment modes for esophageal cancer including left and right thoracic approaches and its corresponding lymph node dissection modes (two-field or three-field) are widely practiced. Different surgical approaches may influence lymph node dissection results, and it may eventually affect the survival of the esophageal cancer patients, therefore, individual selection of appropriate surgical approaches and lymph node dissection extent for esophageal cancer patients based on precise preoperative examinations and clinical stages is very important. By summarizing the recent domestic and foreign research results, it demonstrates that 2-field lymph node dissection by right approach is more radical than left approach, 3-field lymph node dissection by right approach is more radical than 2-field right approach, and may eventually improve the prognosis of patients. However, most of them are retrospective studies which need large sample randomized controlled trials support. This article reviews and summarizes recently published literatures, and discuss the selection of surgical approach and the extent of lymph node dissection for esophageal cancer from three aspects that the effect of left and right thoracic approach on lymph node dissection and prognosis, how to choose individual surgical approach by different position and stage, and what kind of patients need right thoracic approaches with 3-field lymph node dissection.
Subject(s)
Female , Humans , Male , China , Clinical Decision-Making , Methods , Clinical Protocols , Esophageal Neoplasms , General Surgery , Esophagectomy , Methods , Lymph Node Excision , Methods , Prognosis , Thoracic Surgical Procedures , MethodsABSTRACT
Esophageal carcinoma is one of the most prevalent malignancies in China. Surgical treatment remains to be important in the treatment for esophageal carcinoma. However, controversies exist in the surgical treatment for esophageal carcinoma including selection of appropriate surgical approach, extent of lymph node dissection, and optimization of minimally invasive esophagectomy processes and make it comparable to the open esophagectomy. All above disputed issues will be resolved through multi-center randomized controlled studies using clinical research network platform in the future. The clinical evidences produced by these studies will be used for revision of guidelines for esophageal carcinoma.
Subject(s)
Humans , Carcinoma , General Surgery , China , Esophageal Neoplasms , General Surgery , Esophagectomy , Lymph Node ExcisionABSTRACT
<p><b>OBJECTIVE</b>Video-assisted thoracoscopic (VATS) esophagectomy has been performed for more than 10 years in China. However, compared with the conventional esophagectomy via right thoracotomy, whether VATS esophagectomy has more advantages or not in the lymph node (LN) dissection and prevention of perioperative complications is still controversial and deserves to be further investigated. The aim of this study was to explore whether there are significant differences in this issue between the two surgical modalities or not.</p><p><b>METHODS</b>The results of lymph node dissection and perioperative complications as well as other parameters in the patients treated by VATS esophagectomy and those by conventional esophagectomy via right thoracotomy at our department from May 1, 2009 to July 30, 2013 were compared using SPSS 16.0 in order to investigate whether there was any significant difference between these two treatment modalities in the learning curve stage of VATS esophagectomy.</p><p><b>RESULTS</b>One hundred and twenty-nine cases underwent VATS esophagectomy between May 1, 2009 and July 30, 2013, and another part 129 cases with the same preoperative cTNM stage treated by conventional esopahgectomy via right thoracotomy were selected in order to compare the results of lymph node dissection and perioperative complications as well as other parameters between those two groups of patients. There were no significant differences in the sex, age, lesion locations and cTNM stage between these two groups. The total LN metastatic rate in the VATS esophagectomy group was 35.7% and that of the conventional esophagectomy group was 37.2% (P > 0.05). The total average number of dissected lymph nodes was 12.1 vs. 16.2 (P < 0.001). The average dissected LN stations was 3.2 vs. 3.6 (P = 0.038). The total average number of dissected LN along the left recurrent laryngeal nerve was 2.0 vs. 3.7 (P = 0.012). The total average number of dissected LN along the right recurrent laryngeal nerve was 2.9 vs. 3.4 (P = 0.231). However, there was no significant difference in the total average number of dissected LN in the other thoracic LN stations, and in the perioperative complications between the two groups. The total postoperative complication rate was 41.1% in the VATS group versus 42.6% in the conventional group (P = 0.801). The cardiopulmonary complication rate was 25.6% vs. 27.1% (P = 0.777). The death rate was the same in the two groups (0.8%). The VATS group had less blood infusion (23.2% vs. 41.8%, P = 0.001) and shorter hospital stay (15.9 days vs. 19.2 days, P = 0.049) but longer operating time (161.3 min vs. 127.8 min, P < 0.01).</p><p><b>CONCLUSIONS</b>In the learning curve stage of VATS esophagectomy, compared with the conventional esophagectomy, less LN number and stations can be dissected in the VATS group due to un-skillful VATS manipulation, especially it is more difficult in the LN dissection along the left recurrent laryngeal nerve. Therefore, it is more suitable to select patients with early esophageal cancer without obvious enlarged lymph nodes for VATS esophagectomy in the learning curve stage.</p>