Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2019

01-11-2019 | Esophagus Resection | Thoracic Oncology

Thoracic Duct Resection During Esophagectomy Does Not Contribute to Improved Prognosis in Esophageal Squamous Cell Carcinoma: A Propensity Score Matched-Cohort Study

Authors: Taro Oshikiri, MD, Gosuke Takiguchi, MD, Susumu Miura, MD, Hironobu Goto, MD, Dai Otsubo, MD, Hiroshi Hasegawa, MD, Masashi Yamamoto, MD, Shingo Kanaji, MD, Kimihiro Yamashita, MD, Takeru Matsuda, MD, Yasuhiro Fujino, MD, Masahiro Tominaga, MD, Tetsu Nakamura, MD, Satoshi Suzuki, MD, Yoshihiro Kakeji, MD

Published in: Annals of Surgical Oncology | Issue 12/2019

Login to get access

Abstract

Purpose

Esophagectomy with extended lymphadenectomy remains the mainstay of treatment for localized esophageal squamous cell carcinoma (ESCC). Thoracic duct (TD) resection has been recommended as part of extended lymphadenectomy, although its merits are unclear. The aim of this two-institutional, matched-cohort study is to clarify whether TD resection improves prognosis in esophagectomy for ESCC.

Patients and Methods

In this two-institutional, matched-cohort study of 399 patients with ESCC who underwent McKeown esophagectomy between 2010 and 2014, the primary outcomes were overall survival (OS), disease-free survival (DFS), and cause-specific survival (CSS). Secondary outcomes were perioperative results and recurrence patterns.

Results

Based on a propensity score, 122 TD-resected or 122 TD-preserved patients in all stages were selected (median follow-up 4.5 years). The 5-year OS, DFS, and CSS rates in the TD-resected versus TD-preserved groups were 49% versus 60%, 53% versus 57%, and 58% versus 70%, respectively, without any significant differences. Operative time for the thoracic procedure was significantly longer and the number of retrieved mediastinal nodes was significantly higher in the TD-resected group (P = 0.009 and 0.005, respectively). The rates of chylothorax and left recurrent laryngeal nerve (RLN) palsy were significantly higher in the TD-resected group (P = 0.041 and 0.018, respectively). There were no significant differences in rates of local or distant metastases between the two groups.

Conclusions

TD resection does not contribute to improve OS, DFS, or CSS in ESCC but increases incidence of chylothorax and left RLN palsy. Prophylactic TD resection should be avoided in esophagectomy for ESCC.
Literature
1.
Torek F. The first successful case of resection of the thoracic portion of the oesophagus for carcinoma. Surg Gynecol Obstet. 1913;16:614–7.
2.
Altorki NK, Zhou XK, Stiles B, Port JL, Paul S, Lee PC, Mazumdar M. Total number of resected lymph nodes predicts survival in esophageal cancer. Ann Surg. 2008;248:221–6.PubMedCrossRef
3.
Rizk NP, Ishwaran H, Rice TW, et al. Optimum lymphadenectomy for esophageal cancer. Ann Surg. 2010;251:46–50.PubMedCrossRef
4.
Ando N, Ozawa S, Kitagawa Y, Shinozawa Y, Kitajima M. Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg. 2000;232:225–32.PubMedPubMedCentralCrossRef
5.
Udagawa H, Ueno M, Shinohara H, Haruta S, Lee S, Momose K, Tsurumaru M. Shoud lymph nodes along the thoracic duct be dissected routinely in radical esophagectomy? Esophagus. 2014;11:204–10.CrossRef
6.
Matsuda S, Takeuchi H, Kawakubo H, et al. Clinical outcome of transthoracic esophagectomy with thoracic duct resection: number of dissected lymph node and distribution of lymph node metastasis around the thoracic duct. Medicine (Baltimore). 2016;95:e3839.PubMedPubMedCentralCrossRef
7.
Imamura M, Shimada Y, Kanda T, et al. Hemodynamic changes after resection of thoracic duct for en bloc resection of esophageal cancer. Surg Today. 1992;22:226–32.PubMedCrossRef
8.
Aiko S, Yoshizumi Y, Matsuyama T, Sugiura Y, Maehara T. Influences of thoracic duct blockage on early enteral nutrition for patients who underwent esophageal cancer surgery. Jpn J Thorac Cardiovasc Surg. 2003;51:263–71.PubMedCrossRef
9.
McKeown KC: Trends in oesophageal resection for carcinoma with special reference to total oesophagectomy. Ann R Coll Surg Engl. 1972,51:213–39.PubMedPubMedCentral
10.
Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors. 7th ed. Oxford: Wiley; 2010.
11.
Sakai Y, Kitano S. Practice guidelines on endoscopic surgery for qualified surgeons by the endoscopic surgical skill qualification system. Asian J Endosc Surg. 2015;8:103–13.PubMedCrossRef
12.
Rosenbaum PR, Rubin DB. The central role of the propensityscore in observational studies for causal effects. Biometrika. 1983;70:41–55.CrossRef
13.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.PubMedPubMedCentralCrossRef
14.
Hou X, Fu JH, Wang X, et al. Prophylactic thoracic duct ligation has unfavorable impact on overall survival in patients with resectable oesophageal cancer. Eur J Surg Oncol. 2014;40:1756–62.PubMedCrossRef
15.
Murakami G, Sato I, Shimada K, Dong C, Kato Y, Imazeki T. Direct lymphatic drainage from the esophagus into the thoracic duct. Surg Radiol Anat. 1994;16:399–407.PubMedCrossRef
16.
Marshall Jr WH, Neyazaki T, Abrams HL. Abnormal protein loss after thoracic-duct ligation in dogs. N Engl J Med. 1965;273:1092–4.PubMedCrossRef
17.
Annegers JH. Absorption of lipid following thoracic duct ligation in the rat. Am J Physiol. 1959;196:363–4.PubMedCrossRef
18.
19.
Wasmuth-Pietzuch A, Hansmann M, Bartmann P, Heep A. Congenital chylothorax: lymphopenia and high risk of neonatal infections. Acta Paediatr. 2004;93:220–4.PubMedCrossRef
20.
Orange JS, Geha RS, Bonilla FA. Acute chylothorax in children: selective retention of memory T cells and natural killer cells. J Pediatr. 2003;143:243–9.PubMedCrossRef
21.
Cavriani G, Domingos HV, Oliveira-Filho RM, Sudo-Hayashi LS, Vargaftig BB, de Lima WT. Lymphatic thoracic duct ligation modulates the serum levels of IL-1beta and IL-10 after intestinal ischemia/reperfusion in rats with the involvement of tumor necrosis factor alpha and nitric oxide. Shock. 2007;27:209–13.PubMedCrossRef
22.
Baba Y, Yoshida N, Shigaki H, et al. Prognostic impact of postoperative complications in 502 patients with surgically resected esophageal squamous cell carcinoma: a retrospective single-institution study. Ann Surg. 2016;264:305–11.PubMedCrossRef
23.
Krzeszinski JY, Schwaid AG, Cheng WY, Jin Z, Gallegos ZR, Saghatelian A, Wan Y. Lipid osteoclastokines regulate breast cancer bone metastasis. Endocrinology. 2017;158:477–89.PubMedCrossRef
24.
Schurink B, Defize IL, Mazza E, et al. Two-field lymphadenectomy during esophagectomy: the presence of thoracic duct lymph nodes. Ann Thorac Surg. 2018;106:435–9.PubMedCrossRef
25.
Shah RD, Luketich JD, Schuchert MJ, Christie NA, Pennathur A, Landreneau RJ, Nason KS. Postesophagectomy chylothorax: incidence, risk factors, and outcomes. Ann Thorac Surg. 2012;93:897–903.PubMedPubMedCentralCrossRef
26.
Dugue L, Sauvanet A, Farges O, Goharin A, Le Mee J, Belghiti J. Output of chyle as an indicator of treatment for chylothorax complicating oesophagectomy. Br J Surg. 1998;85:1147–9.PubMedCrossRef
27.
Nair SK, Petko M, Hayward MP. Aetiology and management of chylothorax in adults. Eur J Cardiothorac Surg. 2007;32: 362–9.PubMedCrossRef
28.
Dougenis D, Walker WS, Cameron EW, Walbaum PR. Management of chylothorax complicating extensive esophageal resection. Surg Gynecol Obstet. 1992;174:501–6.PubMed
29.
Ohkura Y, Ueno M, Shindoh J, Iizuka T, Ka H, Udagawa H. Risk factors for postoperative chylothorax after radical subtotal esophagectomy. Ann Surg Oncol. 2018;25:2739–46.PubMedCrossRef
30.
Fu JH, Hu Y, Huang WZ, Yang H, Zhu ZH, Zheng B. Evaluating prophylactic ligation of thoracic duct during radical resection of esophageal carcinoma. Ai Zheng. 2006;25:728–30.PubMed
Metadata
Title
Thoracic Duct Resection During Esophagectomy Does Not Contribute to Improved Prognosis in Esophageal Squamous Cell Carcinoma: A Propensity Score Matched-Cohort Study
Authors
Taro Oshikiri, MD
Gosuke Takiguchi, MD
Susumu Miura, MD
Hironobu Goto, MD
Dai Otsubo, MD
Hiroshi Hasegawa, MD
Masashi Yamamoto, MD
Shingo Kanaji, MD
Kimihiro Yamashita, MD
Takeru Matsuda, MD
Yasuhiro Fujino, MD
Masahiro Tominaga, MD
Tetsu Nakamura, MD
Satoshi Suzuki, MD
Yoshihiro Kakeji, MD
Publication date
01-11-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 12/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07627-x

Other articles of this Issue 12/2019

Annals of Surgical Oncology 12/2019 Go to the issue

Breast Oncology

Identifying Residual Nodal Disease in Sentinel Lymph Node Surgery After Neoadjuvant Chemotherapy for Breast Cancer

Health Services Research and Global Oncology

Perioperative Use of Nonsteroidal Anti-inflammatory Drugs Decreases the Risk of Recurrence of Cancer After Colorectal Resection: A Cohort Study Based on Prospective Data

Hepatobiliary Tumors

Dynamic Changes in Normal Liver Parenchymal Volume During Chemotherapy for Colorectal Cancer: Liver Atrophy as an Alternate Marker of Chemotherapy-Associated Liver Injury

Hepatobiliary Tumors

The Impact of Dedicated Cancer Centers on Outcomes Among Medicare Beneficiaries Undergoing Liver and Pancreatic Cancer Surgery

ASO Author Reflections

ASO Author Reflections: Margin Analysis in Head and Neck Cancer—State of the Art and Future Directions

Breast Oncology

Trends in Unilateral and Contralateral Prophylactic Mastectomy Use in Ductal Carcinoma In Situ of the Breast: Patterns and Predictors