Download PDF
Thorac Cardiovasc Surg 2018; 66(05): 370-375
DOI: 10.1055/s-0037-1602259
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Effect of Prophylactic Thoracic Duct Ligation in Reducing the Incidence of Postoperative Chylothorax during Esophagectomy: A Systematic Review and Meta-analysis

Yiyan Lei
1   Department of Thoracic Surgery, Sun Yat-sen University, the First Affiliated Hospital, Guangzhou, Guangdong, P. R. China
,
Yanfen Feng
2   State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P. R. China
3   Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P. R. China
,
Bo Zeng
1   Department of Thoracic Surgery, Sun Yat-sen University, the First Affiliated Hospital, Guangzhou, Guangdong, P. R. China
,
Xin Zhang
1   Department of Thoracic Surgery, Sun Yat-sen University, the First Affiliated Hospital, Guangzhou, Guangdong, P. R. China
,
Jingfu Chen
4   Department of Oncology, The Third People's Hospital of Dongguan City, Dongguan, Guangdong, P. R. China
,
Jianyong Zou
1   Department of Thoracic Surgery, Sun Yat-sen University, the First Affiliated Hospital, Guangzhou, Guangdong, P. R. China
,
Chunhua Su
1   Department of Thoracic Surgery, Sun Yat-sen University, the First Affiliated Hospital, Guangzhou, Guangdong, P. R. China
,
Zhenguo Liu
1   Department of Thoracic Surgery, Sun Yat-sen University, the First Affiliated Hospital, Guangzhou, Guangdong, P. R. China
,
Honghe Luo
1   Department of Thoracic Surgery, Sun Yat-sen University, the First Affiliated Hospital, Guangzhou, Guangdong, P. R. China
,
Shuishen Zhang
1   Department of Thoracic Surgery, Sun Yat-sen University, the First Affiliated Hospital, Guangzhou, Guangdong, P. R. China
› Author Affiliations Funding This study was funded by grants from Medical Scientific Research Foundation of Guangdong Province (A2014217 for L.Y.Y., A2014246 for F.Y.Y., and A2016297 for Z.B.).
Further Information

Publication History

22 January 2017

20 March 2017

Publication Date:
02 May 2017 (online)

    Permissions and Reprints All articles of this category

Abstract

Objectives There is no consensus on the effectiveness of prophylactic thoracic duct ligation (PLG) in esophagectomy for reducing the incidence of postoperative chylothorax. We performed a systemic review and meta-analysis to study its efficacy.

Methods A systemic review of the publications was performed on three databases to identify all the relevant literature on comparative outcomes of PLG and nonprophylactic thoracic duct ligation (NPLG). The primary end point was the incidence of postoperative chylothorax.

Results Seven studies with comparative data on PLG (n = 2,178) versus NPLG (n = 3,048) were identify from the current publications. Comparison showed no significant difference between PLG and NPLG on the incidence of postoperative chylothorax (relative risk = 0.431; 95% confidence interval, 0.186 to 1.002; p = 0.050).

Conclusions Although some studies showed that PLG during the esophagectomy was effective to lower the incidence of postoperative chylothorax, no evidence was observed in the present meta-analysis. Further research is warranted to validate the findings.

Keywords

prophylactic thoracic duct ligation - chylothorax - esophagectomy - meta-analysis
 

  • References

  • 1 Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011; 61 (02) 69-90
    CrossrefPubMedGoogle Scholar
  • 2 Kinugasa S, Tachibana M, Yoshimura H. , et al. Postoperative pulmonary complications are associated with worse short- and long-term outcomes after extended esophagectomy. J Surg Oncol 2004; 88 (02) 71-77
    CrossrefPubMedGoogle Scholar
  • 3 Takeuchi H, Miyata H, Gotoh M. , et al. A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg 2014; 260 (02) 259-266
    CrossrefPubMedGoogle Scholar
  • 4 Vincent JL, Hall JB. Encyclopedia of Intensive Care Medicine. In: Laura J, Moore MD. Chylothorax. Berlin Heidelberg: Springer-Verlag; 2012: 557-559
    Google Scholar
  • 5 Merigliano S, Molena D, Ruol A. , et al. Chylothorax complicating esophagectomy for cancer: a plea for early thoracic duct ligation. J Thorac Cardiovasc Surg 2000; 119 (03) 453-457
    CrossrefPubMedGoogle Scholar
  • 6 Dougenis D, Walker WS, Cameron EW, Walbaum PR. Management of chylothorax complicating extensive esophageal resection. Surg Gynecol Obstet 1992; 174 (06) 501-506
    PubMedGoogle Scholar
  • 7 Fu JH, Hu Y, Huang WZ. , et al. [Evaluating prophylactic ligation of thoracic duct during radical resection of esophageal carcinoma]. Ai Zheng 2006; 25 (06) 728
    PubMedGoogle Scholar
  • 8 Lu JJ, Hou BP, Yao D. , et al. [Effect of thoracic duct ligation during transthoracic esophagectomy on the prevention of post-operative chylothorax in different tumor locations]. Zhonghua Wei Chang Wai Ke Za Zhi 2008; 11 (01) 36-38
    PubMedGoogle Scholar
  • 9 Cagol M, Ruol A, Castoro C, Alfieri R, Michieletto S, Ancona E. Prophylactic thoracic duct mass ligation prevents chylothorax after transthoracic esophagectomy for cancer. World J Surg 2009; 33 (08) 1684-1686
    CrossrefPubMedGoogle Scholar
  • 10 Lai FC, Chen L, Tu YR, Lin M, Li X. Prevention of chylothorax complicating extensive esophageal resection by mass ligation of thoracic duct: a random control study. Ann Thorac Surg 2011; 91 (06) 1770-1774
    CrossrefPubMedGoogle Scholar
  • 11 Guo W, Zhao YP, Jiang YG. , et al. Prevention of postoperative chylothorax with thoracic duct ligation during video-assisted thoracoscopic esophagectomy for cancer. Surg Endosc 2012; 26 (05) 1332-1336
    CrossrefPubMedGoogle Scholar
  • 12 Hou X, Fu JH, Wang X. , et al. Prophylactic thoracic duct ligation has unfavorable impact on overall survival in patients with resectable oesophageal cancer. Eur J Surg Oncol 2014; 40 (12) 1756-1762
    CrossrefPubMedGoogle Scholar
  • 13 Wemyss-Holden SA, Launois B, Maddern GJ. Management of thoracic duct injuries after oesophagectomy. Br J Surg 2001; 88 (11) 1442-1448
    CrossrefPubMedGoogle Scholar
  • 14 McGrath EE, Blades Z, Anderson PB. Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med 2010; 104 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 15 Staats BA, Ellefson RD, Budahn LL, Dines DE, Prakash UB, Offord K. The lipoprotein profile of chylous and nonchylous pleural effusions. Mayo Clin Proc 1980; 55 (11) 700-704
    PubMedGoogle Scholar
  • 16 Choh CTP, Khan OA, Rychlik IJ, McManus K. Does ligation of the thoracic duct during oesophagectomy reduce the incidence of post-operative chylothorax?. Int J Surg 2012; 10 (04) 203-205
    CrossrefPubMedGoogle Scholar
  • 17 Linden Philip A, Swanson Scott J. Esophageal resection and replacement. In: Sellke FW, del Nido Pj, Swanson SJ. , eds. Sabiston & Spencer Surgery of the Chest, vol. I, 7th ed. Philadelphia, PA: Elsevier Saunders; 2005: 627-651
    Google Scholar
  • 18 Jadad AR, Moore RA, Carroll D. , et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials 1996; 17 (01) 1-12
    CrossrefPubMedGoogle Scholar
  • 19 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25 (09) 603-605
    CrossrefPubMedGoogle Scholar
  • 20 Wells GA, Shea BJ, O'Connell D. , et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of non randomized studies in meta-analysis. Available at: http://www.ohri.ca/programs/clinicalepidemiology/oxford.asp . Accessed November 10, 2015
    PubMedGoogle Scholar
  • 21 Cochran WG. The combination of estimates from different experiments. Biometrics 1954; 10 (01) 101-129
    CrossrefPubMedGoogle Scholar
  • 22 Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315 (7109): 629-634
    CrossrefPubMedGoogle Scholar
  • 23 Sauvanet A. [Surgery technique: preventive ligation of the thoracic duct during esophagectomy for cancer]. Ann Chir 2002; 127 (03) 228-231
    CrossrefPubMedGoogle Scholar
  • 24 Hoeppner J, Hopt UT. Transabdominal mass ligation of the thoracic duct for the prevention of chylothorax following en bloc oesophagectomy. Eur J Cardiothorac Surg 2013; 44 (06) 1134-1136
    CrossrefPubMedGoogle Scholar
  • 25 Shen Y, Feng M, Khan MA, Wang H, Tan L, Wang Q. A simple method minimizes chylothorax after minimally invasive esophagectomy. J Am Coll Surg 2014; 218 (01) 108-112
    CrossrefPubMedGoogle Scholar
  • 26 Jiwnani S, Karimundackal G, Mehta M, Pramesh CS. Is prophylactic thoracic duct ligation warranted in all patients undergoing esophagectomy?. Ann Thorac Surg 2011; 92 (06) 2302 , author reply 2302
    PubMedGoogle Scholar
  • 27 Liu JP, Zhang YH, Yang B, Chen Q, Cao L. Influence of thoracic duct ligation on the lipid metabolism of patients with esophageal carcinoma after esophagectomy. Genet Mol Res 2015; 14 (01) 2527-2536
    CrossrefPubMedGoogle Scholar
  • 28 Loeweneck H, Feifel G. Lanz Wachsmuth Praktische Anatomie Bauch. Heidelberg, Germany: Springer; 2003: 470
    Google Scholar
  • 29 Shah RD, Luketich JD, Schuchert MJ. , et al. Postesophagectomy chylothorax: incidence, risk factors, and outcomes. Ann Thorac Surg 2012; 93 (03) 897-903 , discussion 903–904
    CrossrefPubMedGoogle Scholar
  • 30 Cha EM, Sirijintakarn P. Anatomic variation of the thoracic duct and visualization of mediastinal lymph nodes: a lymphographic study. Radiology 1976; 119 (01) 45-48
    CrossrefPubMedGoogle Scholar
  • 31 Zilversmit DB. The composition and structure of lymph chylomicrons in dog, rat, and man. J Clin Invest 1965; 44 (10) 1610-1622
    CrossrefPubMedGoogle Scholar
  • 32 Marshall Jr WH, Neyazaki T, Abrams HL. Abnormal protein loss after thoracic-duct ligation in dogs. N Engl J Med 1965; 273 (20) 1092-1094
    CrossrefPubMedGoogle Scholar
  • 33 Shackcloth MJ, Poullis M, Lu J, Page RD. Preventing of chylothorax after oesophagectomy by routine pre-operative administration of oral cream. Eur J Cardiothorac Surg 2001; 20 (05) 1035-1036
    CrossrefPubMedGoogle Scholar