Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan.
Dis Esophagus. 2023 Sep 1;36(9). doi: 10.1093/dote/doad002.
We have reported the possible benefits of radical esophagectomy with thoracic duct (TD) resection in elective esophageal cancer surgery. However, the effect of TD resection on the long-term nutrition status remains unclear.
Patients who underwent esophagectomy at Keio University between January 2006 and December 2018 were included, and those who had no recurrence for more than three years were evaluated. Changes in each body composition (muscle mass and body fat) were comparatively assessed between those who underwent TD resection or not, before and at, one, three and five years after surgery. Computed tomography images were analyzed on postoperative year 1, 3 and 5.
This study included 217 patients categorized in the TD-resected (TD-R) (156 patients) and TD-preserved (TD-P) (61 patients) groups. The loss of muscle mass was comparable between the groups. On the other hand, the loss of adipose tissues was significantly greater in the TD-R group than in the TD-P group at one and three years after surgery, while there was no statistical difference five years after surgery. Additionally, among patients with cT1N0M0 disease in whom survival advantage of TD resection has been reported previously, the loss of muscle mass did not differ between each group.
The change of muscle mass between the two groups was comparable. Although body fat mass was reduced by TD resection, it eventually recovered in the long term. In patients with esophageal cancer, TD resection may be acceptable without significant impact on body composition in the long term.
我们已经报道了在选择性食管癌手术中根治性食管切除术联合胸导管（TD）切除的可能益处。然而，TD 切除对长期营养状况的影响尚不清楚。
纳入了 2006 年 1 月至 2018 年 12 月期间在庆应义塾大学接受食管切除术的患者，并评估了无复发超过 3 年的患者。比较了接受和未接受 TD 切除的患者在手术前后 1 年、3 年和 5 年时的身体成分（肌肉质量和体脂）变化。术后第一年、第三年和第五年进行计算机断层扫描图像分析。
本研究纳入了 217 例患者，分为 TD 切除（TD-R）组（156 例）和 TD 保留（TD-P）组（61 例）。两组的肌肉质量丢失相当。另一方面，在手术后 1 年和 3 年，TD-R 组的脂肪组织丢失明显大于 TD-P 组，而在手术后 5 年，两组之间没有统计学差异。此外，在先前报道 TD 切除有生存优势的 cT1N0M0 疾病患者中，两组之间的肌肉质量丢失没有差异。
两组之间肌肉质量的变化相当。尽管 TD 切除减少了体脂量，但在长期内它最终会恢复。在食管癌患者中，TD 切除可能是可以接受的，不会对身体成分产生长期的显著影响。
