Nijssen David J, van der Aa Dillen C, Ali Mahsoem, Kazemier Geert, Jamaludin Faridi S, Eshuis Wietse J, van Berge Henegouwen Mark I, Gisbertz Suzanne S
Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Cancer Center Amsterdam, Cancer Treatment and Quality of Life, 1066 CX Amsterdam, The Netherlands.
Cancers (Basel). 2025 Mar 13;17(6):967. doi: 10.3390/cancers17060967.
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.
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.
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, = 0.043), but also increased risk of chyle leakage (odds ratio [OR]: 2.41, 95% CI: 1.04-5.61, = 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, = 0.48). TD ligation showed no significant differences in 5-year OS (HR: 1.15, 95% CI: 0.81-1.63, = 0.33) or morbidity compared to TD preservation. Certainty of evidence was low across outcomes.
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.
背景/目的：在食管癌切除术中，胸导管（TD）的处理方式——切除、结扎或保留——其效果仍存在争议。本系统评价和荟萃分析旨在评估TD处理策略对肿瘤学结局和手术并发症的影响。
按照PRISMA报告指南进行系统评价和荟萃分析。检索OVID、Embase和科学网，以确定在食管癌切除术中比较胸导管切除或TD结扎与TD保留的研究。结局指标包括5年总生存率（OS）、术后并发症、术后乳糜漏、淋巴结获取数量和住院时间。采用Hartung-Knapp-Sidik-Jonkman方差校正进行随机效应荟萃分析。
共纳入17项研究，涉及4200例患者。TD切除与显著更高的淋巴结获取数量相关（平均差[MD]：4，95%置信区间[CI]：0至8，P = 0.043），但也增加了乳糜漏的风险（比值比[OR]：2.41，95% CI：1.04 - 5.61，P = 0.044）。与TD保留相比，TD切除在5年OS方面没有显著改善（风险比[HR]：0.94，95% CI：0.76 - 1.17，P = 0.48）。与TD保留相比，TD结扎在5年OS（HR：1.15，95% CI：0.81 - 1.63，P = 0.33）或并发症方面没有显著差异。各结局指标的证据确定性较低。
TD切除可增加淋巴结获取数量，但与更高的乳糜漏发生率相关，且总体生存率没有显著改善。与TD保留相比，TD结扎对肿瘤学或手术结局没有显著影响。需要更高质量的证据来确定TD处理策略对肿瘤学和手术的确切影响。
