Effect of Resection of the Thoracic Duct and Surrounding Lymph Nodes on Short- and Long-Term and Nutritional Outcomes After Esophagectomy for Esophageal Cancer

Yoshida, Naoya; Nagai, Yoshinori; Baba, Yoshifumi; Miyamoto, Yuji; Iwagami, Shiro; Iwatsuki, Masaaki; Hiyoshi, Yukiharu; Eto, Kojiro; Ishimoto, Takatsugu; Kiyozumi, Yuki; Nomoto, Daichi; Akiyama, Takahiko; Imamura, Yu; Watanabe, Masayuki; Baba, Hideo

doi:10.1245/s10434-019-07304-z

Cited by 25 publications

(24 citation statements)

References 18 publications

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“…In patients with cT1 N0 disease, pathological tumour stage was comparable between groups. The present findings are supported by a recent study showing that, in clinical stage I disease, overall survival tended to be longer among patients who underwent resection of the thoracic duct.…”

Section: Discussionsupporting

confidence: 88%

“…Thoracic duct ligation has been reported to induce retroperitoneal fluid retention, leading to intravenous volume loss after surgery. Finally, Yoshida and colleagues reported that thoracic duct resection was related to pulmonary complications. In the present analysis, thoracic duct resection with radical lymphadenectomy did not increase the occurrence of postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

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Minimally invasive oesophagectomy with extended lymph node dissection and thoracic duct resection for early-stage oesophageal squamous cell carcinoma

Matsuda

Kawakubo

Takeuchi

et al. 2020

British Journal of Surgery

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Background: Oesophageal squamous cell carcinoma is an aggressive disease owing to early and widespread lymph node metastases. Multimodal therapy and radical surgery may improve prognosis. Few studies have investigated the efficacy of radical lymph node and thoracic duct resection. Methods: Patients with oesophageal squamous cell carcinoma who underwent transthoracic minimally invasive oesophagectomy (TMIE) for cancer at Keio University Hospital betweenJanuary 2004 and December 2016 were selected. Between 2004 and 2008, TMIE was performed in the lateral decubitus position without thoracic duct resection (standard TMIE). From 2009 onwards, TMIE with extended lymph node and thoracic duct resection was introduced (extended TMIE). Demographics, co-morbidity, number of retrieved lymph nodes, pathology, postoperative complications and recurrence-free survival (RFS) were compared between groups. Results: Forty-four patients underwent standard TMIE and 191 extended TMIE. There were no significant differences in clinical and pathological tumour stage or postoperative complications. The extended-TMIE group had more lymph nodes removed at nodal stations 106recL and 112. Among patients with cT1 N0 disease, RFS was better in the extended-TMIE group (P < 0⋅001), whereas there was no difference in RFS between groups in patients with advanced disease. Conclusion: Extended TMIE including thoracic duct resection increased the number of lymph nodes retrieved and was associated with improved survival in patients with cT1 N0 oesophageal squamous cell carcinoma.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Minimally invasive oesophagectomy with extended lymph node dissection and thoracic duct resection for early-stage oesophageal squamous cell carcinoma

Matsuda

Kawakubo

Takeuchi

et al. 2020

British Journal of Surgery

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“…Yoshida et al described that TD resection would increase the incidence of pulmonary comorbidity. 12,13 Since the anticipated benefits need to outweigh the potential risks, prospective studies that validate these previous results are warranted.…”

Section: Discussionmentioning

confidence: 93%

Prognostic impact of thoracic duct lymph node metastasis in esophageal squamous cell carcinoma

Matsuda

Kawakubo

Takeuchi

et al. 2021

Annals of Gastroent Surgery

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“…For example, PLG has been shown to increase the incidence of post-operative chylothorax and left recurrent laryngeal nerve (RLN) palsy (21). In addition, it has also been clari ed that routine PLG is not necessary (19,20). Furthermore, Hou (10) and Chen (18) investigated the effect of PLG on long-term survival, and reported that the PLG group had a lower 5-year survival rate than the NPLG group (48.2% vs. 61.6%, P < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Effect of Prophylactic Ligation of the Thoracic Duct on Long-Term Survival in Patients Undergoing Esophagectomy: A Meta-Analysis

M¹,

Chao²,

Long³

et al. 2021

Preprint

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Objective: To evaluate the existing literature by comparing long-term survival between patients who underwent prophylactic thoracic duct ligation (PLG) and non-prophylactic thoracic duct ligation (NPLG) during esophagectomy for esophageal cancer, a meta-analysis of relevant studies was conducted.Background: The effect of PLG and NPLG on the long-term survival in patients undergoing esophagectomy for treatment of esophageal cancer has not been established.Methods: All articles searches were performed in PubMed, Cochrane, Embase, and Web of Science, and the deadline is August 31, 2020. The search terms included esophagectomy AND thoracic duct. The selected articles compared the long-term survival of patients undergoing esophagectomy to treat esophageal cancer with prophylactic thoracic duct ligation (PLG) and non-prophylactic thoracic duct ligation (NPLG). The I2 test and X2 test were used to determine statistical heterogeneity. Publication bias was assessed using the Egger test. The results are presented as hazard ratios (HRs) with 95% confidence intervals (CIs). All data analysis was performed using Stata12.0 software.Result: A total of 4418 patients from eight studies were included in this meta-analysis. Pooled analysis revealed that a high overall survival (OS) was significantly associated with NPLG (HR=0.81, 95% CI: 0.74-0.88, P<.001), while the recurrence- free survival (RFS) and disease-free survival (DFS) were not significantly different (HR=1.02, 95% CI: 0.71-1.45, P<.001). There was no statistical difference in long-term survival among patients with different stages of esophageal cancer, while patients who underwent esophagectomy after 2019 had a better long-term prognosis (HR=0.57, 95% CI: 0.57-0.79). In addition, there was no significant difference in prognosis and survival between patients in Japan and China based on regional analysis.Conclusions: Our meta-analysis showed that NPLG was associated with better long-term survival. Thus, we should preserve the thoracic duct during esophageal cancer surgery.

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Effect of Resection of the Thoracic Duct and Surrounding Lymph Nodes on Short- and Long-Term and Nutritional Outcomes After Esophagectomy for Esophageal Cancer

Cited by 25 publications

References 18 publications

Minimally invasive oesophagectomy with extended lymph node dissection and thoracic duct resection for early-stage oesophageal squamous cell carcinoma

Minimally invasive oesophagectomy with extended lymph node dissection and thoracic duct resection for early-stage oesophageal squamous cell carcinoma

Prognostic impact of thoracic duct lymph node metastasis in esophageal squamous cell carcinoma

Effect of Prophylactic Ligation of the Thoracic Duct on Long-Term Survival in Patients Undergoing Esophagectomy: A Meta-Analysis

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