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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

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, Yu Imamura MD, PhD, Masayuki Watanabe MD, PhD, Hideo Baba MD, PhD
Thoracic Oncology
Online First ™ - March , 2019

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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