The effect of prophylactic thoracic duct ligation during esophagectomy on the incidence of chylothorax and survival of the patients: an updated review

Лю, Лэй; Gong, Longbo; Zhang, Miao; Wu, Wenbin

doi:10.1080/00325481.2020.1803666

Cited by 9 publications

(5 citation statements)

References 28 publications

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“…In contrast, Fu et al [45], in their series of 389 patients, reported no significant differences between TDL vs. noTDL (1.2% vs. 0.5%) in terms of postoperative chylothorax. Further, a recent meta-analysis by Liu et al [10], re-elaborating some missing data by Crucitti et al [8], found no significant differences in terms of postoperative chylothorax (OR = 0.73; 95% CI 0.50-1.07). Our meta-analysis supports the data by Fu et al [45] and Lei et al [10] reporting a similar postoperative risk for TDL vs. noTDL (RR = 0.66; 95% CI 0.28-1.56).…”

Section: Discussionmentioning

confidence: 94%

“…Further, a recent meta-analysis by Liu et al [10], re-elaborating some missing data by Crucitti et al [8], found no significant differences in terms of postoperative chylothorax (OR = 0.73; 95% CI 0.50-1.07). Our meta-analysis supports the data by Fu et al [45] and Lei et al [10] reporting a similar postoperative risk for TDL vs. noTDL (RR = 0.66; 95% CI 0.28-1.56). The heterogeneity was low (I 2 = 21%) while the sensitivity analysis seems to confirm the robustness of these data.…”

Section: Discussionmentioning

confidence: 94%

“…It is well-known that HRs change over time and are useful to describe the magnitude and direction of survival outcomes [49]. Notably, two previous meta-analyses assessed HR by reporting a single 5-year follow-up calculation that was presumed constant over the entire duration of the study [9,10]. However, the single interpretation of HRs may be misleading because of the time-dependent modifications.…”

Section: Discussionmentioning

confidence: 99%

“…Because of its central role in immunoregulation, some authors argued that there was an unfavorable effect of TDL on the 5-year overall survival (OS) while two recent metaanalyses reported no significant differences [9,10]. However, selection bias, heterogeneity related to inclusions of studies reporting thoracic duction resection, and the exclusive utilization of HRs constitute limitations.…”

Section: Introductionmentioning

confidence: 99%

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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: 94%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…Rationally, in transthoracic approaches such as Ivor Lewis and Mckeown surgical procedures, if prophylactic thoracic duct mass ligation is done, it is expected that the occurrence of chylothorax should be lower than transhiatal operation that is nearly blind (23). However, reported documents show controversial issues (7,18,(23)(24)(25)(26). In this regard, Tsoon et al ( 5) have reported 14 cases (9%) of chylothorax out of 155 transthoracic esophagectomies.…”

Section: Du Et Al (4)mentioning

confidence: 99%

Incidence of chylothorax over nineteen years of transhiatal esophagectomy: A case series and review study

Mahmodlou

Yousefiazar

2022

Turk J Surg

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Objective: Chylothorax (CTx) is the leak and accumulation of lymphatic fluid within the pleural cavity. The incidence of CTx has the highest rate after esophagectomy. This study aimed to present three cases of post-esophagectomy chylothorax among 612 esophagectomies that were performed over 19 years, in which post-esophagectomy chylothorax was reviewed in terms of risk factors, diagnosis, and management. Material and Methods: Six hundred and twelve patients were included in the study. Transhiatal esophagectomy was used for all patients. In three cases, chylothorax was detected. In all of the three cases, secondary surgery was performed for the management of chylothorax. Mass ligation was performed for the first and third cases having leak from the right side. In the second case, the leak was from the left side without prominent duct; and despite mass ligation that was done several times, no significant reduction in chyle was observed. Results: In the first case, in spite of reduced output, the patient gradually progressed to respiratory distress. His condition deteriorated over time and he died after three days. In the second case that needed third surgery, the patient’s condition deteriorated and she died after two days due to respiratory failure. The third patient had postoperative recovery. The patient was discharged on fifth day after the second operation. Conclusion: In post-esophagectomy chylothorax, the key to preventing high mortality rates can be the identification of risk factors as well as timely detection of symptoms and proper management. Besides, early surgical intervention should be considered to prevent early complications of chylothorax.

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Intra-Nodal Indocyanine Green Injection to Delineate Thoracic Duct During Minimally Invasive Esophagectomy

Varshney

Nayar

Soni

et al. 2022

Journal of Gastrointestinal Surgery

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The effect of prophylactic thoracic duct ligation during esophagectomy on the incidence of chylothorax and survival of the patients: an updated review

Cited by 9 publications

References 28 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

Incidence of chylothorax over nineteen years of transhiatal esophagectomy: A case series and review study

Intra-Nodal Indocyanine Green Injection to Delineate Thoracic Duct During Minimally Invasive Esophagectomy

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