Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Division of Translational Research and Advanced Treatment Against Gastrointestinal Cancer, Kumamoto University, Kumamoto, Japan.
Ann Surg Oncol. 2019 Jun;26(6):1893-1900. doi: 10.1245/s10434-019-07304-z. Epub 2019 Mar 12.
The effect of resection of the thoracic duct (TD) along with surrounding lymph nodes (LN) on short- and long-term outcomes of esophagectomy in esophageal cancer patients is not well defined.
A total of 537 consecutive patients suffering from esophageal cancer who underwent three-incision esophagectomy between April 2005 and August 2018 were eligible for short-term outcome analysis. Among them, 487 patients who underwent surgery before August 2017 were eligible for analysis of long-term outcomes. Moreover, 164 patients who underwent esophagectomy after August 2012 and had no recurrence at 1-year postoperative follow-up were prospectively investigated for postoperative nutritional status.
A total of 145 patients (27.0%) underwent TD resection with surrounding LN. Since the clinical stage was significantly more advanced in the removal group, preoperative treatment was more frequently performed in them. The operative time was significantly longer in the removal group. Intraoperative bleeding was higher in the removal group. Morbidity of Clavien-Dindo classification (CDc) ≥ II and pulmonary morbidities were frequently observed in the removal group. Multivariate analysis suggested that TD resection was an independent risk factor for pulmonary morbidities. Moreover, it may be associated with the incidence of CDc ≥ II morbidity. Greater numbers of LN were dissected in the thorax of patients in the removal group. However, overall survival was equivalent irrespective of the TD procedure in each stage. Nutritional status at 1-year follow-up was equivalent between the groups.
On the basis of the present results, routine removal of the TD during esophagectomy is not recommended.
在食管癌患者中，切除胸导管（TD）及其周围淋巴结（LN）对手术的短期和长期结果的影响尚未明确。
共有 537 例连续的食管癌患者符合三切口食管癌切除术的条件，这些患者于 2005 年 4 月至 2018 年 8 月间接受了手术。其中，487 例于 2017 年 8 月前接受手术的患者符合长期结果分析的条件。此外，164 例于 2012 年 8 月后接受手术且术后 1 年随访时无复发的患者前瞻性地接受了术后营养状况调查。
共有 145 例（27.0%）患者接受了 TD 及其周围 LN 的切除术。由于移除组的临床分期明显更晚，因此术前治疗在该组中更频繁地进行。移除组的手术时间明显更长。移除组术中出血量较高。移除组中 Clavien-Dindo 分级（CDc）≥Ⅱ级和肺部并发症的发病率较高。多因素分析表明，TD 切除术是肺部并发症的独立危险因素。此外，它可能与 CDc≥Ⅱ级发病率相关。移除组患者的胸部解剖出更多的 LN。然而，无论在每个阶段是否进行 TD 手术，总生存率均无差异。在 1 年随访时，两组的营养状况相当。
根据目前的结果，不建议在食管癌手术中常规切除 TD。
