Prognosis of Patients with Esophageal Carcinoma After Routine Thoracic Duct Resection

A Propensity-matched Analysis of 12,237 Patients Based on the Comprehensive Registry of Esophageal Cancer in Japan

Oshikiri, Taro MD, PhD^*; Numasaki, Hodaka MD, PhD^†; Oguma, Junya MD, PhD^‡; Toh, Yasushi MD, PhD^§; Watanabe, Masayuki MD, PhD^¶; Muto, Manabu MD, PhD^||; Kakeji, Yoshihiro MD, PhD^*; Doki, Yuichiro MD, PhD^**

Objective: 

To clarify whether routine thoracic duct (TD) resection improves the prognosis of patients with esophageal cancer after radical esophagectomy.

Summary of 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: 

After propensity score matching, 1638 c-Stage I–IV patients participated in each group. The 5 year overall survival and cause-specific survival rates were 57.5% and 65.6% in the TD-resected group and 55.2% 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 esoph-ageal 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.