Effect of azygos arch preservation during thoracoscopic esophagectomy on facilitation of postoperative refilling

Fujiwara, Naoto; Satô, Hiroshi; Miyawaki, Yutaka; Ito, Michiho; Aoyama, Junya; Ito, Sunao; Oya, Shuichiro; Watanabe, Kenji; Sugita, Hirofumi; Sakuramoto, Shinichi

doi:10.1007/s00423-020-01994-w

Cited by 2 publications

(2 citation statements)

References 32 publications

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“…The potential advantages of TDR are a higher total number of retrieved lymph nodes and a reduced risk of nodal and hematogenous recurrence after radical esophagectomy [58][59][60][61]. However, TDR seems associated with an increased risk of short-term adverse outcomes such as chylothorax, left recurrent nerve palsy, pulmonary complications, and hemodynamic instability that may be somewhat related to the concomitant azygos vein ligation/resection [60][61][62][63][64]. Nevertheless, TDR with the preservation of the azygos vein has been reported during robot-assisted thoracoscopic esophagectomy with no substantial effect on the total number of harvested lymph nodes [65][66][67].…”

Section: Discussionmentioning

confidence: 99%

Does Thoracic Duct Ligation at the Time of Esophagectomy Impact Long-Term Survival? An Individual Patient Data Meta-Analysis

Aiolfi,

Bona,

Calì

et al. 2024

JCM

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Background: Thoracic duct ligation (TDL) during esophagectomy has been proposed to reduce the risk of postoperative chylothorax. Because of its role in immunoregulation, some authors argued that it had an unfavorable TDL effect on survival. The aim of this study was to analyze the effect of TDL on overall survival (OS). Methods: PubMed, MEDLINE, Scopus, and Web of Science were searched through December 2023. The primary outcome was 5-year OS. The restricted mean survival time difference (RMSTD), hazard ratios (HRs), and 95% confidence intervals (CI) were used as pooled effect size measures. The GRADE methodology was used to summarize the certainty of the evidence. Results: Five studies (3291 patients) were included. TDL was reported in 54% patients. The patients’ age ranged from 49 to 69, 76% were males, and BMI ranged from 18 to 26. At the 5-year follow-up, the combined effect from the multivariate meta-analysis is -3.5 months (95% CI −6.1, −0.8) indicating that patients undergoing TDL lived 3.5 months less compared to those without TDL. TDL was associated with a significantly higher hazard for mortality at 12 months (HR 1.54, 95% CI 1.38–1.73), 24 months (HR 1.21, 95% CI 1.12–1.35), and 28 months (HR 1.14, 95% CI 1.02–1.28). TDL and noTDL seem comparable in terms of the postoperative risk for chylothorax (RR = 0.66; p = 0.35). Conclusions: In this study, concurrent TDL was associated with reduced 5-year OS after esophagectomy. This may suggest the need of a rigorous follow-up within the first two years of follow-up.

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Section: Discussionmentioning

confidence: 99%

Does Thoracic Duct Ligation at the Time of Esophagectomy Impact Long-Term Survival? An Individual Patient Data Meta-Analysis

Aiolfi,

Bona,

Calì

et al. 2024

JCM

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“…AAP during thoracic esophagectomy is an uncommon technique that has been described in only a few publications to date [ 21 , 28 ]. Whether AAP is clinically justified was rarely discussed until the recent study by Fujiwara et al [ 29 ], who comparatively analyzed the relationship between surgical outcomes and AAP in 119 patients undergoing MIE for EC and, interestingly, suggested that the achievement of AAP during thoracoscopic esophagectomy might enhance post-surgical urinary output. They also provided data on perioperative blood loss, which did not differ significantly between patients with and those without AAP, thus apparently contradicting our present results.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Blood Loss During Thoracoscopic Esophagectomy for Esophageal Carcinoma

et al. 2021

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Background: Major intraoperative hemorrhage reportedly predicts unfavorable survival outcomes following surgical resection for esophageal carcinoma (EC). However, the factors predicting the amount of blood lost during thoracoscopic esophagectomy have yet to be sufficiently studied. We sought to identify risk factors for excessive blood loss during video-assisted thoracoscopic surgery (VATS) for EC. Methods: Using simple and multiple linear regression models, we performed retrospective analyses of the associations between clinicopathological/surgical factors and estimated hemorrhagic volume in 168 consecutive patients who underwent VATS-type esophagectomy for EC. Results:The median blood loss amount was 225 mL (interquartile range, 126-380 mL). Abdominal laparotomy (p<0.001), thoracic duct resection (p=0.014), and division of the azygos arch (p<0.001) were significantly related to high volumes of blood loss. Body mass index and operative duration, as continuous variables, were also correlated positively with blood loss volume in simple linear regression. The multiple linear regression analysis identified prolonged operative duration (p<0.001), open laparotomy approach (p=0.003), azygos arch division (p=0.005), and high body mass index (p=0.014) as independent predictors of higher hemorrhage amounts during VATS esophagectomy. Conclusion:As well as body mass index, operation-related factors such as operative duration, open laparotomy, and division of the azygos arch were independently predictive of estimated blood loss during VATS esophagectomy for EC. Laparoscopic abdominal procedures and azygos arch preservation might be minimally invasive options that would potentially reduce intraoperative hemorrhage, although oncological radicality remains an important consideration.

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Effect of azygos arch preservation during thoracoscopic esophagectomy on facilitation of postoperative refilling

Cited by 2 publications

References 32 publications

Does Thoracic Duct Ligation at the Time of Esophagectomy Impact Long-Term Survival? An Individual Patient Data Meta-Analysis

Does Thoracic Duct Ligation at the Time of Esophagectomy Impact Long-Term Survival? An Individual Patient Data Meta-Analysis

Factors Affecting Blood Loss During Thoracoscopic Esophagectomy for Esophageal Carcinoma

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