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Is Thoracic Duct Resection Necessary for Esophageal Squamous Cell Carcinoma Patients Treated with Neoadjuvant Chemoradiotherapy? A Propensity-Matched Analysis Based on the Comprehensive Registry of Esophageal Cancer in Japan

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

Abstract

Background

The thoracic duct (TD) plays an important role in nutrition and immunity but is often resected with the esophagus when dissecting surrounding lymph nodes in patients with esophageal squamous cell carcinoma (ESCC). We examined whether indiscriminate TD resection improved the prognosis of patients with ESCC treated with neoadjuvant chemoradiotherapy (NACRT) followed by esophagectomy.

Methods

A total of 440 patients treated with NACRT followed by esophagectomy between 2007 and 2012 were analyzed using data from the Comprehensive Registry of Esophageal Cancer in Japan. The propensity score-matched TD resection and TD preservation groups were compared in terms of short- and long-term outcomes.

Results

After matching, there were 85 patients in both groups. No significant differences were found between groups in either overall survival or cause-specific survival rates at 5 years: 44.2% and 49.0% in the TD resection group, and 39.8% and 47.2% in the TD preservation group, respectively. Furthermore, the number of retrieved mediastinal lymph nodes was significantly greater in the TD resection group than in the TD preservation group (26 vs. 15, p < 0.0001). In contrast, TD resection was associated with metastasis to a significantly greater number of distant organs than TD preservation (49 vs. 32, p = 0.049).

Conclusions

TD resection did not contribute to improved survival in patients with ESCC but did lead to metastases in more organs than TD preservation. Consequently, indiscriminate TD resection might be avoided in patients with ESCC treated with NACRT followed by esophagectomy.

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Acknowledgment

The authors sincerely appreciate all participants in the CRECJ for their considerable effort in data registration. They also thank the working members of the Japan Esophageal Society database committee (Tsuneo Oyama, MD; Hisahiro Matsubara, MD; Masaki Ueno, MD; Koji Kono, MD; Takashi Uno, MD; Ryu Ishihara, MD; Kei Muro, MD; Soji Ozawa, MD; Koji Tanaka, MD; Kentaro Murakami, MD; Hiroshi Saeki, MD; Yoshio Toshiyuki, MD; and Tsushima Takahiro, MD). The authors did not preregister this research in an independent, institutional registry.

Funding

Research expenses from our department were used for publication.

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan

    Taro Oshikiri MD, PhD & Yoshihiro Kakeji MD, PhD

  2. Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan

    Hodaka Numasaki PhD

  3. Division of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan

    Junya Oguma MD, PhD

  4. Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan

    Yasushi Toh MD, PhD

  5. Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Masayuki Watanabe MD, PhD

  6. Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Manabu Muto MD, PhD

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

    Yuichiro Doki MD, PhD

Authors
  1. Taro Oshikiri MD, PhD
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  2. Hodaka Numasaki PhD
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  3. Junya Oguma MD, PhD
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  4. Yasushi Toh MD, PhD
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  5. Masayuki Watanabe MD, PhD
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  6. Manabu Muto MD, PhD
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  8. Yuichiro Doki MD, PhD
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Corresponding author

Correspondence to Taro Oshikiri MD, PhD.

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Disclosure

Taro Oshikiri, Hodaka Numasaki, Junya Oguma, Yasushi Toh, Masayuki Watanabe, Manabu Muto, Yoshihiro Kakeji, and Yuichiro Doki have no conflict of interest to declare.

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Oshikiri, T., Numasaki, H., Oguma, J. et al. Is Thoracic Duct Resection Necessary for Esophageal Squamous Cell Carcinoma Patients Treated with Neoadjuvant Chemoradiotherapy? A Propensity-Matched Analysis Based on the Comprehensive Registry of Esophageal Cancer in Japan. Ann Surg Oncol 30, 2691–2698 (2023). https://doi.org/10.1245/s10434-022-12891-5

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