Shigeno Takashi, Okuno Keisuke, Ogo Taichi, Tanioka Toshiro, Kawada Kenro, Fujiwara Hisashi, Kagawa Hiroyasu, Tokunaga Masanori, Fushimi Kiyohide, Kinugasa Yusuke
Department of Gastrointestinal Surgery, Institute of Science Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Department of Gastrointestinal Surgery, Institute of Science Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Surg Oncol. 2025 Sep 4;63:102279. doi: 10.1016/j.suronc.2025.102279.
Recently, thoracic duct embolization (TDE) has been increasingly adopted as a first-line minimally invasive therapy for post-esophagectomy chylothorax instead of thoracoscopic thoracic duct ligation (TTDL). However, the therapeutic efficacy and advantages of TDE over TTDL are still controversial. This study aimed to evaluate and compare the clinical and financial outcomes of TDE and TTDL for post-operative chylothorax after esophagectomy using a national database.
We retrieved data from patients with esophageal cancer who underwent TDE (n = 312) or TTDL (n = 167) for chylothorax after esophagectomy between April 2012 and March 2022 from the Diagnosis Procedure Combination database in Japan. We compared the success rate of the first intervention, length of post-interventional hospital stay, and total hospitalization cost between the TDE and TTDL groups using propensity score matching analysis.
The success rate of the first intervention was significantly higher in the TTDL group than in the TDE group (odds ratio, 6.13; 95 % confidence interval [CI], 3.25 to 11.55). The length of post-interventional hospital stay was significantly shorter (regression coefficient, -14.8 days; 95 % CI, -26.7 to -2.9) and the total hospitalization cost was significantly lower in the TTDL group than in the TDE group (regression coefficient, -1,258,212 yen; 95 % CI, -2,082,407 to -434,017).
This nationwide cohort study showed that TTDL was associated with a shorter length of post-interventional hospital stay, lower total hospitalization cost, and higher success rate of the first intervention than TDE for post-esophagectomy chylothorax.
最近，胸导管栓塞术（TDE）已越来越多地被用作食管切除术后乳糜胸的一线微创治疗方法，而非胸腔镜胸导管结扎术（TTDL）。然而，TDE相对于TTDL的治疗效果和优势仍存在争议。本研究旨在使用国家数据库评估和比较TDE和TTDL治疗食管切除术后乳糜胸的临床和经济结果。
我们从日本诊断程序组合数据库中检索了2012年4月至2022年3月期间因食管切除术后乳糜胸接受TDE（n = 312）或TTDL（n = 167）治疗的食管癌患者的数据。我们使用倾向得分匹配分析比较了TDE组和TTDL组首次干预的成功率、干预后住院时间和总住院费用。
TTDL组首次干预的成功率显著高于TDE组（优势比，6.13；95%置信区间[CI]，3.25至11.55）。TTDL组干预后的住院时间显著缩短（回归系数，-14.8天；95%CI，-26.7至-2.9），总住院费用显著低于TDE组（回归系数，-1,258,212日元；95%CI，-2,082,407至-434,017）。
这项全国性队列研究表明，对于食管切除术后乳糜胸，与TDE相比TTDL的干预后住院时间更短、总住院费用更低，且首次干预的成功率更高。
