Resection vs. Ligation vs. Preservation of the Thoracic Duct During Esophagectomy for Cancer: A Systematic Review and Meta-Analysis.

IF 4.5 2区医学 Q1 ONCOLOGY

Cancers Pub Date : 2025-03-13 DOI:10.3390/cancers17060967

David J Nijssen, Dillen C van der Aa, Mahsoem Ali, Geert Kazemier, Faridi S Jamaludin, Wietse J Eshuis, Mark I van Berge Henegouwen, Suzanne S Gisbertz

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引用次数: 0

Abstract

Background/objectives: The effect of thoracic duct (TD) management-resection, ligation, or preservation-during esophagectomy for cancer remains controversial. This systematic review and meta-analysis aimed to assess the impact of TD management strategies on oncological outcomes and surgical morbidity.

Methods: A systematic review and meta-analysis were performed following PRISMA reporting guidelines. Searches of OVID, Embase, and Web of Science identified studies comparing thoracic duct resection or TD ligation with TD preservation in esophagectomy for cancer. Outcomes included 5-year overall survival (OS), postoperative morbidity, postoperative chyle leakage, lymph node yield, and length of stay. Random-effects meta-analyses using the Hartung-Knapp-Sidik-Jonkman variance correction were conducted.

Results: A total of 17 studies involving 4200 patients were included. TD resection was associated with a significantly higher lymph node yield (mean difference [MD]: 4, 95% CI: 0 to 8, p = 0.043), but also increased risk of chyle leakage (odds ratio [OR]: 2.41, 95% CI: 1.04-5.61, p = 0.044). There was no significant improvement in 5-year OS with TD resection compared to TD preservation (hazard ratio [HR]: 0.94, 95% CI: 0.76-1.17, p = 0.48). TD ligation showed no significant differences in 5-year OS (HR: 1.15, 95% CI: 0.81-1.63, p = 0.33) or morbidity compared to TD preservation. Certainty of evidence was low across outcomes.

Conclusions: TD resection increases lymph node yield but is associated with higher rates of chyle leakage, without a significantly improved overall survival. TD ligation does not significantly affect oncological or surgical outcomes compared to TD preservation. A higher grade of evidence is needed to determine the definitive oncological and surgical impact of TD management strategies.

查看原文本刊更多论文

食管癌切除术中切除胸导管与结扎胸导管与保留胸导管：系统回顾与元分析》。

背景/目的：在食管癌切除术中切除、结扎或保留胸导管（TD）的效果仍存在争议。本系统综述和荟萃分析旨在评估胸导管管理策略对肿瘤治疗效果和手术发病率的影响：方法：按照 PRISMA 报告指南进行了系统回顾和荟萃分析。通过对 OVID、Embase 和 Web of Science 的检索，确定了在癌症食管切除术中比较胸导管切除或 TD 结扎与保留 TD 的研究。结果包括 5 年总生存率 (OS)、术后发病率、术后糜烂渗漏、淋巴结产量和住院时间。采用 Hartung-Knapp-Sidik-Jonkman 方差校正进行随机效应荟萃分析：结果：共纳入 17 项研究，涉及 4200 名患者。TD切除术与显著较高的淋巴结得率相关（平均差[MD]：4，95% CI：0~8，P = 0.043），但也增加了糜烂渗漏的风险（几率比[OR]：2.41，95% CI：1.04~5.61，P = 0.044）。与保留 TD 相比，TD 切除术的 5 年 OS 没有明显改善（危险比 [HR]：0.94，95% CI：0.76-1.17，p = 0.48）。与保留 TD 相比，TD 结扎术在 5 年生存率（HR：1.15，95% CI：0.81-1.63，p = 0.33）或发病率方面无明显差异。所有结果的证据确定性均较低：结论：TD切除术可增加淋巴结产量，但与较高的糜烂渗漏率相关，且不能显著提高总生存率。与保留TD相比，TD结扎对肿瘤学或手术结果没有明显影响。要确定TD管理策略对肿瘤学和手术的确切影响，还需要更高等级的证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancers Medicine-Oncology

CiteScore

8.00

自引率

9.60%

发文量

5371

审稿时长

18.07 days

期刊介绍： Cancers (ISSN 2072-6694) is an international, peer-reviewed open access journal on oncology. It publishes reviews, regular research papers and short communications. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced.