Abstract

Background

Chylothorax remains a challenging and potentially life-threatening postoperative complication after minimally invasive esophagectomy (MIE). The effect of intraoperative prophylactic thoracic duct ligation on preventing postoperative chylothorax still remains controversial. Moreover, the potential impact of thoracic duct ligation on long-term outcome after MIE has not been well established.

Methods

From September 2009 to July 2018, a total of 600 consecutive patients suffering from thoracic esophageal cancer who underwent thoracoscopic–laparoscopic McKeown esophagectomy in the Department of Thoracic surgery at Daping hospital were eligible. Among them, 559 patients received esophagectomy with preventive thoracic duct ligation and 41 patients did not. Propensity score matching (PSM) was performed to improve comparability between the two groups. Log-rank test was used to assess the survival differences between groups.

Results

Postoperative chylothorax occurred in five patients in the preservation group (PG) and in seven patients in the ligation group (LG) (12.2% vs. 1.3%, P = 0.001). The median age of the patients in the preservation group (PG) was 57.78 (range, 37–76) years, while the median age in the ligation group (LG) was 62.75 (range, 39–87) years. The PG had more patients with tumor located in middle thoracic esophagus and stage T3 than LG, 82.9% vs. 55.6%, 70.7% vs. 45.6%, respectively. After PSM (40 matched patients in PG and 134 in LG), there was no significant between-group difference with respect to age, tumor location, and T stage. The median survival times for patients in the PG and LG were 69.5 months (95% interval confidence, CI 54.6–84.3) and 65.2 months (95% CI 56.3–74.1), respectively (P = 0.977). The 5-year survival rates were comparable between PG and LG (54.9% vs. 54.4%, P = 0.977).

Conclusion

On the basis of the present results, routine thoracic duct ligation during minimally invasive McKeown esophagectomy for cancer is an effective and safe method for prevention of postoperative chylothorax, and does not exert unfavourable effect on long-term survival.

中文翻译：

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胸腔镜-腹腔镜McKeown食管癌切除术中预防性胸导管结扎的近期和长期结果：倾向评分匹配分析

摘要

背景

在微创食管切除术（MIE）后，胸腔胸腔手术仍然是具有挑战性且可能危及生命的术后并发症。术中预防性胸导管结扎术对预防术后乳糜胸的效果仍存在争议。而且，MIE后胸导管结扎对长期预后的潜在影响尚未得到充分证实。

方法

从2009年9月至2018年7月，在大坪医院胸外科接受胸腔镜-腹腔镜McKeown食管切除术的连续600例胸段食管癌患者符合条件。其中559例患者接受了预防性胸导管结扎术的食管切除术，而41例则没有。进行倾向得分匹配（PSM）以提高两组之间的可比性。使用对数秩检验来评估各组之间的生存差异。

结果

保存组（PG）中有5例患者发生了术后乳糜胸，结扎组（LG）中有7例患者发生了术后乳糜胸（12.2％vs. 1.3％，P  = 0.001）。保存组（PG）患者的中位年龄为57.78（范围37-76）岁，结扎组（LG）患者的中位年龄为62.75（范围39-87）岁。PG患者位​​于胸中段食管和T3期的比例高于LG，分别为82.9％对55.6％，70.7％对45.6％。PSM后（PG中40例匹配患者，LG中134例匹配患者），在年龄，肿瘤位置和T期方面，组间无显着差异。PG和LG患者的中位生存时间分别为69.5个月（95％区间置信度，CI 54.6-84.3）和65.2个月（95％CI 56.3-74.1）（P = 0.977）。PG和LG的5年生存率相当（54.9％对54.4％，P  = 0.977）。

结论

根据目前的结果，在微创McKeown食管癌切除术中常规行胸导管结扎术是预防术后乳糜胸的有效且安全的方法，并且不会对长期生存产生不利影响。