Skip to main content
SpringerLink
Log in

Thoracic Duct Resection Has a Favorable Impact on Prognosis by Preventing Hematogenous Spread of Esophageal Cancer Cells: A Multi-institutional Analysis of 2269 Patients

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

Abstract

Background

The impact of thoracic duct (TD) resection on prognosis is controversial. This study aimed to examine the impact of TD resection.

Methods

In this six-institution, matched-cohort study, 2269 consecutive patients with esophageal squamous cell carcinoma who underwent esophagectomy between 2000 and 2017 were enrolled for analysis of long-term outcomes, including overall survival (OS), disease-free survival (DFS), cause-specific survival (CSS), and recurrence patterns.

Results

Based on a propensity score, 642 TD-resected and 642 TD-preserved patients with all stages of disease were selected. At 5 years, the TD-resected group had an OS of 57.7%, a DFS of 50.9%, and a CSS of 62.2%. These rates were significantly higher than the corresponding rates of 48.7% (p = 0.0078), 41.0% (p = 0.0297), and 55.3% (p = 0.0473) in the TD-preserved group. The OS in the TD-preserved and TD-resected groups was similar for the patients with cStage 1 or 2 (p = 0.6265), but it was significantly higher in the TD-resected group for the patients with cStage 3 or 4 (p = 0.0052). The incidence of total recurrence did not differ between the two groups. However, the incidence of hematogenous recurrence in the TD-resected group (19.0%) was significantly lower than in the TD-preserved group (26.2%) (p = 0.0021). For cT4a tumors, the incidence of local recurrence in the TD-resected group (2.4%) was significantly lower than in the TD-preserved group (18.4%) (p = 0.0183).

Conclusions

Performance of TD resection may help to improve prognosis, especially for patients with advanced esophageal squamous cell carcinoma, by reducing hematogenous and local recurrence. Prospective trials are needed to determine whether prophylactic TD resection has a positive impact on the prognosis of patients with esophageal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.

Similar content being viewed by others

References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.

    Article  Google Scholar 

  2. Pennathur A, Gibson MK, Jobe BA, Luketich JD. Oesophageal carcinoma. Lancet. 2013;381:400–12.

    Article  Google Scholar 

  3. Udagawa H, Ueno M, Shinohara H, et al. Should lymph nodes along the thoracic duct be dissected routinely in radical esophagectomy? Esophagus. 2014;11:204–10.

    Article  Google Scholar 

  4. Japan Esophageal S. Japanese classification of esophageal cancer, 11th edition: part I. Esophagus. 2017;14:1–36.

    Article  Google Scholar 

  5. Matsuda S, Takeuchi H, Kawakubo H, 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. Med Baltim. 2016;95:e3839.

    Article  CAS  Google Scholar 

  6. Imamura M, Shimada Y, Kanda T, et al. Hemodynamic changes after resection of thoracic duct for en bloc resection of esophageal cancer. Surg Today. 1992;22:226–32.

    Article  CAS  Google Scholar 

  7. 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;51:263–71.

    Article  Google Scholar 

  8. 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. 2019;26:1893–900.

    Article  Google Scholar 

  9. Yamasaki M, Yasuda T, Yano M, et al. Multicenter randomized phase II study of cisplatin and fluorouracil plus docetaxel (DCF) compared with cisplatin and fluorouracil plus adriamycin (ACF) as preoperative chemotherapy for resectable esophageal squamous cell carcinoma (OGSG1003). Ann Oncol. 2016;28:116–20.

    Article  Google Scholar 

  10. Yamashita K, Katada N, Moriya H, et al. Neoadjuvant chemotherapy of triplet regimens of docetaxel/cisplatin/5-FU (DCF NAC) may improve patient prognosis of cStage II/III esophageal squamous cell carcinoma-propensity score analysis. Gen Thorac Cardiovasc Surg. 2016;64:209–15.

    Article  Google Scholar 

  11. Cuesta MA, van der Wielen N, Straatman J, van der Peet DL. Video-assisted thoracoscopic esophagectomy: keynote lecture. Gen Thorac Cardiovasc Surg. 2016;64:380–5.

    Article  Google Scholar 

  12. Yamasaki M, Miyata H, Fujiwara Y, et al. Minimally invasive esophagectomy for esophageal cancer: comparative analysis of open and hand-assisted laparoscopic abdominal lymphadenectomy with gastric conduit reconstruction. J Surg Oncol. 2011;104:623–8.

    Article  Google Scholar 

  13. Wada H, Doki Y, Nishioka K, et al. Clinical outcome of esophageal cancer patients with history of gastrectomy. J Surg Oncol. 2005;89:67–74.

    Article  Google Scholar 

  14. Watanabe M, Mine S, Nishida K, Kurogochi T, Okamura A, Imamura Y. Reconstruction after esophagectomy for esophageal cancer patients with a history of gastrectomy. Gen Thorac Cardiovasc Surg. 2016;64:457–63.

    Article  Google Scholar 

  15. Japan Esophageal S. Japanese classification of esophageal cancer, 11th edition: part II and III. Esophagus. 2017;14:37–65.

    Article  Google Scholar 

  16. 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;33:1684–6.

    Article  Google Scholar 

  17. 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;91:1770–4.

    Article  Google Scholar 

  18. 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;26:1332–6.

    Article  Google Scholar 

  19. Lin Y, Li Z, Li G, et al. Selective en masse ligation of the thoracic duct to prevent chyle leak after esophagectomy. Ann Thorac Surg. 2017;103:1802–7.

    Article  Google Scholar 

  20. Lei Y, Feng Y, Zeng B, et al. Effect of prophylactic thoracic duct ligation in reducing the incidence of postoperative chylothorax during esophagectomy: a systematic review and meta-analysis. Thorac Cardiovasc Surg. 2018;66:370–5.

    Article  Google Scholar 

  21. 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;40:1756–62.

    Article  CAS  Google Scholar 

  22. Oshikiri T, Takiguchi G, Miura S, et al. Thoracic duct resection during esophagectomy does not contribute to improved prognosis in esophageal squamous cell carcinoma: a propensity score-matched cohort study. Ann Surg Oncol. 2019;26:4053–61.

    Article  Google Scholar 

  23. Bao T, Wang YJ, Li KK, Liu XH, Guo W. Short- and long-term outcomes of prophylactic thoracic duct ligation during thoracoscopic-laparoscopic McKeown esophagectomy for cancer: a propensity score-matching analysis. Surg Endosc. 2019;34:5023–9.

    Article  Google Scholar 

  24. Murakami G, Sato I, Shimada K, Dong C, Kato Y, Imazeki T. Direct lymphatic drainage from the esophagus into the thoracic duct. Surg Radiol Anat. 1994;16:399–407.

    Article  CAS  Google Scholar 

  25. Oshiro H, Osaka Y, Tachibana S, Aoki T, Tsuchiya T, Nagao T. Retrograde lymphatic spread of esophageal cancer: a case report. Med Baltim. 2015;94:e1139.

    Article  Google Scholar 

  26. Kaifi JT, Kunkel M, Das A, et al. Circulating tumor cell isolation during resection of colorectal cancer lung and liver metastases: a prospective trial with different detection techniques. Cancer Biol Ther. 2015;16:699–708.

    Article  CAS  Google Scholar 

  27. Li W, Zhou X, Huang Z, et al. Laparoscopic surgery minimizes the release of circulating tumor cells compared to open surgery for hepatocellular carcinoma. Surg Endosc. 2015;29:3146–53.

    Article  Google Scholar 

  28. Hashimoto M, Tanaka F, Yoneda K, et al. Positive correlation between postoperative tumor recurrence and changes in circulating tumor cell counts in pulmonary venous blood (pvCTC) during surgical manipulation in non-small cell lung cancer. J Thorac Dis. 2018;10:298–306.

    Article  Google Scholar 

  29. Tamminga M, de Wit S, van de Wauwer C, et al. Analysis of released circulating tumor cells during surgery for non-small cell lung cancer. Clin Cancer Res. 2020;26:1656–66.

    Article  CAS  Google Scholar 

  30. Tanaka K, Yano M, Motoori M, et al. CEA-antigen and SCC-antigen mRNA expression in peripheral blood predict hematogenous recurrence after resection in patients with esophageal cancer. Ann Surg Oncol. 2010;17:2779–86.

    Article  Google Scholar 

  31. Crucitti P, Mangiameli G, Petitti T, 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;50:1019–24.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan

    Koji Tanaka MD, PhD, Makoto Yamasaki MD, PhD, Kotaro Yamashita MD, PhD, Tomoki Makino MD, PhD, Hidetoshi Eguchi MD, PhD & Yuichiro Doki MD, PhD

  2. Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan

    Keijiro Sugimura MD, PhD, Hiroshi Miyata MD, PhD & Masahiko Yano MD, PhD

  3. Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan

    Osamu Shiraishi MD, PhD, Yutaka Kimura MD, PhD & Takushi Yasuda MD, PhD

  4. Department of Surgery, Osaka General Medical Center, Osaka, Japan

    Masaaki Motoori MD, PhD

  5. Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan

    Takuya Hamakawa MD, PhD & Motohiro Hirao MD, PhD

  6. Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan

    Atsushi Takeno MD, PhD

Authors
  1. Koji Tanaka MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Makoto Yamasaki MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Keijiro Sugimura MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Osamu Shiraishi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masaaki Motoori MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takuya Hamakawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Atsushi Takeno MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kotaro Yamashita MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tomoki Makino MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yutaka Kimura MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hiroshi Miyata MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Motohiro Hirao MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hidetoshi Eguchi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Takushi Yasuda MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Masahiko Yano MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Yuichiro Doki MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Koji Tanaka MD, PhD.

Ethics declarations

Disclosure

There are no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PPTX 120 KB)

Supplementary file2 (DOCX 14 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tanaka, K., Yamasaki, M., Sugimura, K. et al. Thoracic Duct Resection Has a Favorable Impact on Prognosis by Preventing Hematogenous Spread of Esophageal Cancer Cells: A Multi-institutional Analysis of 2269 Patients. Ann Surg Oncol 28, 4402–4410 (2021). https://doi.org/10.1245/s10434-021-09962-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-021-09962-4

Search

Navigation