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Annals of Surgical Oncology
Erschienen in:

16.04.2021 | Gastrointestinal Oncology

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

verfasst von: Koji Tanaka, MD, PhD, Makoto Yamasaki, MD, PhD, Keijiro Sugimura, MD, PhD, Osamu Shiraishi, MD, PhD, Masaaki Motoori, MD, PhD, Takuya Hamakawa, MD, PhD, Atsushi Takeno, MD, PhD, Kotaro Yamashita, MD, PhD, Tomoki Makino, MD, PhD, Yutaka Kimura, MD, PhD, Hiroshi Miyata, MD, PhD, Motohiro Hirao, MD, PhD, Hidetoshi Eguchi, MD, PhD, Takushi Yasuda, MD, PhD, Masahiko Yano, MD, PhD, Yuichiro Doki, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 8/2021

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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.
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Literatur
1.
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.CrossRef
2.
Pennathur A, Gibson MK, Jobe BA, Luketich JD. Oesophageal carcinoma. Lancet. 2013;381:400–12.CrossRef
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.CrossRef
4.
Japan Esophageal S. Japanese classification of esophageal cancer, 11th edition: part I. Esophagus. 2017;14:1–36.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
15.
Japan Esophageal S. Japanese classification of esophageal cancer, 11th edition: part II and III. Esophagus. 2017;14:37–65.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
Metadaten
Titel
Thoracic Duct Resection Has a Favorable Impact on Prognosis by Preventing Hematogenous Spread of Esophageal Cancer Cells: A Multi-institutional Analysis of 2269 Patients
verfasst von
Koji Tanaka, MD, PhD
Makoto Yamasaki, MD, PhD
Keijiro Sugimura, MD, PhD
Osamu Shiraishi, MD, PhD
Masaaki Motoori, MD, PhD
Takuya Hamakawa, MD, PhD
Atsushi Takeno, MD, PhD
Kotaro Yamashita, MD, PhD
Tomoki Makino, MD, PhD
Yutaka Kimura, MD, PhD
Hiroshi Miyata, MD, PhD
Motohiro Hirao, MD, PhD
Hidetoshi Eguchi, MD, PhD
Takushi Yasuda, MD, PhD
Masahiko Yano, MD, PhD
Yuichiro Doki, MD, PhD
Publikationsdatum
16.04.2021
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 8/2021
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-021-09962-4

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