Effect of Resection of the Thoracic Duct and Surrounding Lymph Nodes on Short- and Long-Term and Nutritional Outcomes After Esophagectomy for Esophageal Cancer
Effect of Resection of the Thoracic Duct and Surrounding Lymph Nodes on Short- and Long-Term and Nutritional Outcomes After Esophagectomy for Esophageal Cancer
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DOI：
10.1245/s10434-019-07304-z
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发表时间：
2019-06-01
影响因子：
3.7
通讯作者：
Baba, Hideo
中科院分区：
文献类型：
--
作者：
Yoshida, Naoya;Nagai, Yohei;Baba, Hideo
背景胸导管（TD）和周围淋巴结（LN）切除对食管癌患者食管切除术短期和长期结局的影响尚不清楚。方法对2005年4月至2018年8月期间接受三切口食管切除术的连续537例食管癌患者进行短期结局分析。其中，2017年8月之前接受手术的487名患者有资格进行长期结果分析。此外，对2012年8月后接受食管切除术且术后1年随访无复发的164例患者进行术后营养状况前瞻性调查。结果共有145例患者（27.0%）接受了周围淋巴结TD切除术。由于切除组的临床分期明显较高，因此术前治疗的频率更高。切除组的手术时间明显更长。切除组的术中出血较多。在切除组中经常观察到 Clavien-Dindo 分类 (CDc)II 的发病率和肺部发病率。多变量分析表明TD切除是肺部疾病的独立危险因素。此外，它可能与 CDcII 发病率有关。切除组患者胸腔内解剖出较多数量的淋巴结。然而，无论每个阶段采用哪种 TD 手术，总生存率都是相同的。 1 年随访时各组的营养状况相当。结论根据目前的结果，不建议在食管切除术中常规切除 TD。
BackgroundThe 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.MethodsA 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.ResultsA 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 CDcII 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.ConclusionsOn the basis of the present results, routine removal of the TD during esophagectomy is not recommended.