Influence of thoracic duct ligation on the lipid metabolism of patients with esophageal carcinoma after esophagectomy

Abstract

ABSTRACT. The aim of this study was to determine the influence of thoracic duct ligation on the lipid metabolism of patients with esophageal carcinoma after esophagectomy. A total of 74 patients with esophageal carcinoma who underwent esophagectomy were divided into 2 groups according to whether or not their thoracic duct was ligated. Thirty-nine patients were in the thoracic duct ligation group and the other 35 assigned to the control group. Enteral feeding was through a nasojejunal tube from the 1st day to the 8th day after operation, and liquid diet was provided starting on the 6th day. We compared the plasma concentrations of cholesterol (CHOL), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) at different time points. There were no statistically significant differences between the two groups in CHOL, TG and HDL levels at different times. However, LDL levels in the thoracic duct ligation group were significantly lower at different times compared to the other group (P < 0.05), where they were the lowest at the end of the 1st month and then gradually recovered 3 months later. Thoracic duct ligation can effectively prevent chylomicrons from being transferred to the blood, reducing the generation of LDL. The establishment of collateral circulation was slow after the ligation of the thoracic duct, which had a negative effect on early postoperative nutrition of patients.

Effect of Prophylactic Thoracic Duct Ligation in Reducing the Incidence of Postoperative Chylothorax during Esophagectomy: A Systematic Review and Meta-analysis

“…32 Liu et al also reported that thoracic duct ligation could availably keep chylomicrons from being transferred to the blood, decreasing the production of low-density lipoprotiens. 27 The slowdown of collateral circulation establishment would adversely affect the nutrition of patients early after surgery. Moreover, Hou et al revealed that PLG reduced the overall survival of esophageal carcinoma, probably caused by the abnormal return of immune factors and proteins to circulation.…”

“…Of the remaining 13 candidate articles, 3 articles only reported the surgical technique of thoracic duct ligation, [23][24][25] 1 was a review article, 16 1 was a letter, 26 and 1 was a study mainly focused on the influence of thoracic duct ligation on the lipid metabolism. 27 A final total of 7 studies were considered in the meta-analysis. [6][7][8][9][10][11][12] In the included studies, 5,227 cases were enrolled, including 2,178 that underwent PLG and 3,048 that received nonprophylactic thoracic duct ligation (NPLG).…”

Thoracic Duct Narrowing—Innovative Technique Restraining Weight Gain in Rats

“…Our study limitation concerns lack of identified mechanism and long-term TDN follow-up. BDormantl ymphatics anastomoses which re-open after thoracic duct occlusion were suggested by Chen and Itkin [29] and recently by Liu et al [17]. TDN may as well Bactivate^collateral lymphatic channels in parallel with weight regain inhibition, possibly limiting the long-term effect.…”

“…They concluded TD ligation to effectively prevent chylomicrons from being transferred to the blood, reducing the generation of LDL. They also suggested establishment of collateral circulation to be slow after the ligation of the thoracic duct and have a negative effect on early postoperative nutrition of patients [17].…”

Minimally Invasive and Robotic Esophagectomy

“…Mass ligation of the thoracic duct may also affect postoperative nutrition for the first 3 months, reducing blood chylomicrons and low density lipoprotein. 37…”