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Effect of Resection of the Thoracic Duct and Surrounding Lymph Nodes on Short- and Long-Term and Nutritional Outcomes After Esophagectomy for Esophageal Cancer

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

On the basis of the present results, routine removal of the TD during esophagectomy is not recommended.

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References

  1. Schurink B, Defize IL, Mazza E, Ruurda JP, Brosens LAA, Roeling TAP, Bleys RLAW, et al. Two-field lymphadenectomy during esophagectomy: the presence of thoracic duct lymph nodes. Ann Thorac Surg. 2018;106(2):435–9.

    Article  PubMed  Google Scholar 

  2. Anand S, Kalayarasan R, Chandrasekar S, Gnanasekaran S, Pottakkat B. Minimally invasive esophagectomy with thoracic duct resection post neoadjuvant chemoradiotherapy for carcinoma esophagus-impact on lymph node yield and hemodynamic parameters. J Gastrointest Cancer. 2018. https://doi.org/10.1007/s12029-018-0051-1.

    Article  Google Scholar 

  3. Imamura M, Shimada Y, Kanda T, Miyahara T, Hashimoto M, Tobe T, Arai T, et al. Hemodynamic changes after resection of thoracic duct for en bloc resection of esophageal cancer. Surg Today. 1992;22(3):226–32.

    Article  CAS  PubMed  Google Scholar 

  4. Takeno A, Tamura S, Miki H, Tanigawa N, Taniguchi H, Nakahira S, Suzuki R, et al. Chyluria after ligation of the thoracic duct: a rare complication after thoracoscopic-assisted esophagectomy for esophageal cancer. Surg Today. 2014;44(4):757–60.

    Article  PubMed  Google Scholar 

  5. Aiko S, Yoshizumi Y, Matsuyama T, Sugiura Y, Maehara T. Influences of thoracic duct blockage on early enteral nutrition for patients who underwent esophageal cancer surgery. Jpn J Thorac Cardiovasc Surg. 2003;51(7):263–71.

    Article  PubMed  Google Scholar 

  6. Yoshida N, Kosumi K, Tokunaga R, Baba Y, Nagai Y, Miyamoto Y, Iwagami S, et al. Clinical importance of mean corpuscular volume as a prognostic marker after esophagectomy for esophageal cancer: a retrospective study. Ann Surg. 2018. https://doi.org/10.1097/sla.0000000000002971.

    Article  PubMed  Google Scholar 

  7. Sobin LH, Gospodarowicz MK, Wittekind C. International Union against Cancer: TNM classification of malignant tumours. 7th ed. Hoboken: Wiley; 2010.

    Google Scholar 

  8. Society of Thoracic Surgeons General Thoracic Surgery Database Task Force. The Society of Thoracic Surgeons composite score for evaluating esophagectomy for esophageal cancer. Ann Thorac Surg. 2017;103(5):1661–7.

    Article  Google Scholar 

  9. Yoshida N, Baba Y, Shigaki H, Harada K, Iwatsuki M, Kurashige J, Sakamoto Y, et al. Preoperative nutritional assessment by controlling nutritional status (CONUT) is useful to estimate postoperative morbidity after esophagectomy for esophageal cancer. World J Surg. 2018;40(8):1910–7.

    Article  Google Scholar 

  10. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sathornviriyapong S, Matsuda A, Miyashita M, Matsumoto S, Sakurazawa N, Kawano Y, Yamada M, et al. Impact of neoadjuvant chemoradiation on short-term outcomes for esophageal squamous cell carcinoma patients: a meta-analysis. Ann Surg Oncol. 2016;23(11):3632–40.

    Article  PubMed  Google Scholar 

  12. Kumagai K, Rouvelas I, Tsai JA, Mariosa D, Klevebro F, Lindblad M, Ye W, et al. Meta-analysis of postoperative morbidity and perioperative mortality in patients receiving neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal and gastro-oesophageal junctional cancers. Br J Surg. 2014;101(4):321–38.

    Article  CAS  PubMed  Google Scholar 

  13. Crucitti P, Mangiameli G, Petitti T, Condoluci A, Rocco R, Gallo IF, Longo F, et al. Does prophylactic ligation of the thoracic duct reduce chylothorax rates in patients undergoing oesophagectomy? A systematic review and meta-analysis. Eur J Cardiothorac Surg. 2016;50(6):1019–24.

    Article  PubMed  Google Scholar 

  14. 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(6):1770–4.

    Article  PubMed  Google Scholar 

  15. Matsuda S, Takeuchi H, Kawakubo H, Shimada A, Fukuda K, Nakamura R, Takahashi T, et al. Clinical outcome of transthoracic esophagectomy with thoracic duct resection: number of dissected lymph node and distribution of lymph node metastasis around the thoracic duct. Medicine. 2016;95(24):e3839.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, Hiratsuka M, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;359(5):453–62.

    Article  CAS  PubMed  Google Scholar 

  17. Baba Y, Yoshida N, Shigaki H, Iwatsuki M, Miyamoto Y, Sakamoto Y, Watanabe M, et al. Prognostic impact of postoperative complications in 502 patients with surgically resected esophageal squamous cell carcinoma: a retrospective single-institution study. Ann Surg. 2016;264(2):305–11.

    Article  PubMed  Google Scholar 

  18. Harada K, Yoshida N, Baba Y, Nakamura K, Kosumi K, Ishimoto T, Iwatsuki M, et al. Pyloroplasty may reduce weight loss 1 year after esophagectomy. Dis Esophagus. 2018. https://doi.org/10.1093/dote/dox127.

    Article  PubMed  Google Scholar 

  19. Yamasaki M, Miyata H, Yasuda T, Shiraishi O, Takahashi T, Motoori M, Yano M, et al. Impact of the route of reconstruction on post-operative morbidity and malnutrition after esophagectomy: a multicenter cohort study. World J Surg. 2015;39(2):433–40.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

    Naoya Yoshida MD, PhD, Yohei Nagai MD, PhD, Yoshifumi Baba MD, PhD, Yuji Miyamoto MD, PhD, Shiro Iwagami MD, PhD, Masaaki Iwatsuki MD, PhD, Yukiharu Hiyoshi MD, PhD, Kojiro Eto MD, PhD, Takatsugu Ishimoto MD, PhD, Yuki Kiyozumi MD, PhD, Daichi Nomoto MD, Takahiko Akiyama MD & Hideo Baba MD, PhD

  2. Division of Translational Research and Advanced Treatment Against Gastrointestinal Cancer, Kumamoto University, Kumamoto, Japan

    Naoya Yoshida MD, PhD & Takatsugu Ishimoto MD, PhD

  3. Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan

    Yu Imamura MD, PhD & Masayuki Watanabe MD, PhD

Authors
  1. Naoya Yoshida MD, PhD
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  2. Yohei Nagai MD, PhD
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  3. Yoshifumi Baba MD, PhD
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  4. Yuji Miyamoto MD, PhD
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  5. Shiro Iwagami MD, PhD
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  6. Masaaki Iwatsuki MD, PhD
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  8. Kojiro Eto MD, PhD
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  9. Takatsugu Ishimoto MD, PhD
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  12. Takahiko Akiyama MD
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  13. Yu Imamura MD, PhD
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  14. Masayuki Watanabe MD, PhD
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  15. Hideo Baba MD, PhD
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Corresponding author

Correspondence to Hideo Baba MD, PhD.

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Disclosure

Drs. Naoya Yoshida and Takatsugu Ishimoto belong to a department supported by Chugai Pharmaceutical Co., Ltd. and Yakuruto Honsya Co., Ltd., but have no conflict of interest regarding this research. Dr. Yoshifumi Baba belongs to a department supported by Ono Pharmaceutical Co., Ltd., but has no conflict of interest regarding this research. The remaining authors declare that they have no conflict of interest or financial ties to disclose.

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Yoshida, N., Nagai, Y., Baba, Y. et al. Effect of Resection of the Thoracic Duct and Surrounding Lymph Nodes on Short- and Long-Term and Nutritional Outcomes After Esophagectomy for Esophageal Cancer. Ann Surg Oncol 26, 1893–1900 (2019). https://doi.org/10.1245/s10434-019-07304-z

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  • DOI: https://doi.org/10.1245/s10434-019-07304-z

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