Does Thoracic Duct Ligation at the Time of Esophagectomy Impact Long-Term Survival? An Individual Patient Data Meta-Analysis

: Thoracic duct ligation (TDL) during esophagectomy has been proposed to reduce the risk of postoperative chylothorax. Because of its role in immunoregulation, some authors argued that it had an unfavorable TDL effect on survival. The aim of this study was to analyze the effect of TDL on overall sur...

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Bibliographic Details
Published in:Journal of clinical medicine 2024-05, Vol.13 (10), p.2849
Main Authors: Aiolfi, Alberto, Bona, Davide, Calì, Matteo, Manara, Michele, Rausa, Emanuele, Bonitta, Gianluca, Elshafei, Moustafa, Markar, Sheraz R, Bonavina, Luigi
Format: Article
Language:English
Subjects:
Bias
Body mass index
Chylothorax
Esophageal cancer
Esophagus
Influence
Ligature (Surgery)
Meta-analysis
Patients
Prevention
Risk factors
Software upgrading
Statistical analysis
Surgery
Surgical anastomosis
Systematic review
Tumors
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Summary:: Thoracic duct ligation (TDL) during esophagectomy has been proposed to reduce the risk of postoperative chylothorax. Because of its role in immunoregulation, some authors argued that it had an unfavorable TDL effect on survival. The aim of this study was to analyze the effect of TDL on overall survival (OS). : PubMed, MEDLINE, Scopus, and Web of Science were searched through December 2023. The primary outcome was 5-year OS. The restricted mean survival time difference (RMSTD), hazard ratios (HRs), and 95% confidence intervals (CI) were used as pooled effect size measures. The GRADE methodology was used to summarize the certainty of the evidence. : Five studies (3291 patients) were included. TDL was reported in 54% patients. The patients' age ranged from 49 to 69, 76% were males, and BMI ranged from 18 to 26. At the 5-year follow-up, the combined effect from the multivariate meta-analysis is -3.5 months (95% CI -6.1, -0.8) indicating that patients undergoing TDL lived 3.5 months less compared to those without TDL. TDL was associated with a significantly higher hazard for mortality at 12 months (HR 1.54, 95% CI 1.38-1.73), 24 months (HR 1.21, 95% CI 1.12-1.35), and 28 months (HR 1.14, 95% CI 1.02-1.28). TDL and noTDL seem comparable in terms of the postoperative risk for chylothorax (RR = 0.66; = 0.35). : In this study, concurrent TDL was associated with reduced 5-year OS after esophagectomy. This may suggest the need of a rigorous follow-up within the first two years of follow-up.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm13102849