Taro Oshikiri1, Hodaka Numasaki, Junya Oguma, Yasushi Toh, Masayuki Watanabe, Manabu Muto, Yoshihiro Kakeji, Yuichiro Doki. 1. Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Osaka, Japan Division of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Abstract
OBJECTIVE: To clarify whether routine thoracic duct (TD) resection improves the prognosis of patients with esophageal cancer after radical esophagectomy. SUMMARY BACKGROUND DATA: Although TD resection can cause nutritional disadvantage and immune suppression, it has been performed for the resection of surrounding lymph nodes. METHODS: We analyzed 12,237 patients from the Comprehensive Registry of Esophageal Cancer in Japan who underwent esophagectomy between 2007 and 2012. TD resection and preservation groups were compared in terms of prognosis, perioperative outcomes, and initial recurrent patterns using strict propensity score matching. Particularly, the year of esophagectomy and history of primary cancer of other organs were added as covariates. RESULTS: Following propensity score matching, 1638 c-Stage I-IV patients participated in each group. The five-year overall survival and cause-specific survival rates were 57.5% and 55.2% in the TD-resected group and 65.6% and 63.4% in the TD-preserved group, respectively, without significant differences. The TD-resected group had significantly more retrieved mediastinal nodes (30 vs. 21, P < 0.0001) and significantly fewer lymph node recurrence (376 vs. 450, P = 0.0029) compared with the TD-preserved group. However, the total number of distant metastatic organs was significantly greater in TD-resected group than in the TD-preserved group (499 vs. 421, P = 0.0024). CONCLUSIONS: TD resection did not improve survival in patients with esophageal cancer. Despite having retrieved more lymph nodes, TD resection caused distant metastases in more organs compared to TD preservation. Hence, prophylactic TD resection should not be recommended in patients with esophageal cancer.
OBJECTIVE: To clarify whether routine thoracic duct (TD) resection improves the prognosis of patients with esophageal cancer after radical esophagectomy. SUMMARY BACKGROUND DATA: Although TD resection can cause nutritional disadvantage and immune suppression, it has been performed for the resection of surrounding lymph nodes. METHODS: We analyzed 12,237 patients from the Comprehensive Registry of Esophageal Cancer in Japan who underwent esophagectomy between 2007 and 2012. TD resection and preservation groups were compared in terms of prognosis, perioperative outcomes, and initial recurrent patterns using strict propensity score matching. Particularly, the year of esophagectomy and history of primary cancer of other organs were added as covariates. RESULTS: Following propensity score matching, 1638 c-Stage I-IV patients participated in each group. The five-year overall survival and cause-specific survival rates were 57.5% and 55.2% in the TD-resected group and 65.6% and 63.4% in the TD-preserved group, respectively, without significant differences. The TD-resected group had significantly more retrieved mediastinal nodes (30 vs. 21, P < 0.0001) and significantly fewer lymph node recurrence (376 vs. 450, P = 0.0029) compared with the TD-preserved group. However, the total number of distant metastatic organs was significantly greater in TD-resected group than in the TD-preserved group (499 vs. 421, P = 0.0024). CONCLUSIONS: TD resection did not improve survival in patients with esophageal cancer. Despite having retrieved more lymph nodes, TD resection caused distant metastases in more organs compared to TD preservation. Hence, prophylactic TD resection should not be recommended in patients with esophageal cancer.
Authors: Sivesh K Kamarajah; Manjunath Siddaiah-Subramanya; Alessandro Parente; Richard P T Evans; Ademola Adeyeye; Alan Ainsworth; Alberto M L Takahashi; Alex Charalabopoulos; Andrew Chang; Atila Eroglue; Bas Wijnhoven; Claire Donohoe; Daniela Molena; Eider Talavera-Urquijo; Flavio Roberto Takeda; Gail Darling; German Rosero; Guillaume Piessen; Hans Mahendran; Hsu Po Kuei; Ines Gockel; Ionut Negoi; Jacopo Weindelmayer; Jari Rasanen; Kebebe Bekele; Guowei Kim; Lieven Depypere; Lorenzo Ferri; Magnus Nilsson; Frederik Klevebro; B Mark Smithers; Mark I van Berge Henegouwen; Peter Grimminger; Paul M Schneider; C S Pramesh; Raza Sayyed; Richard Babor; Shinji Mine; Simon Law; Suzanne Gisbertz; Tim Bright; Xavier Benoit D'Journo; Donald Low; Pritam Singh; Ewen A Griffiths Journal: Ann Surg Open Date: 2022-08-29