Impact of thoracic duct ligation on substance metabolism and surgical complications in patients with type-2 diabetes mellitus during esophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Xinyu , FEI Xiang , LI Chunguang , ZHAO Yue , LU Qijue , LU Chaojing ,  CHEN Hezhong

Department of Thoracic Surgery, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, 200433, P.R.China;

Corresponding author：

CHEN Hezhong, Email: chzchanghai@163.com

Keywords：

Esophagectomy; thoracic duct ligation; type-2 diabetes mellitus

DOI：

10.7507/1007-4848.201907018

Video：

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Objective To investigate the impact of thoracic duct ligation (TDL) on metabolism and postoperative complications during esophagectomy in patients with type-2 diabetes mellitus (T2DM).Methods We conducted a retrospective clinical data analysis of 230 esophageal carcinoma patients with T2DM who underwent esophagectomy in our hospital from January 2003 to December 2018. Patients were divided into a TDL+ group (n=112), including 78 males and 34 females aged 63.47±7.23 years, and a TDL– group (n=118), including 84 males and 34 females aged 64.38±7.57 years. We compared the blood glucose, liver function parameters and lipid metabolic parameters at different time points before and after surgery. In addition, we compared the postoperative major complications between the two groups. Propensity score-matched (PSM) was used to control the observed confounders.Results Compared with the TDL– group, patients in TDL+ group had higher blood glucose level (P<0.05, except the fourth postoperative day). The total protein and albumin levels on the first and fourth postoperative days in the TDL+ group were lower than those in the TDL– group (P<0.05). The alanine transaminase (P=0.027) and aspartate transaminase (P=0.007) levels on the fourth postoperative day in the TDL+ group were higher than those in the TDL– group. More pulmonary complications (P=0.014) and anastomotic leaks (P=0.047) were found in the TDL+ group.Conclusion Given that TDL may aggravate metabolic disorders, increase anastomotic leaks and the pulmonary complications, it is cautious to perform TDL, and prophylactic TDL should not be performed routinely for patients with T2DM.

Citation： WANG Xinyu, FEI Xiang, LI Chunguang, ZHAO Yue, LU Qijue, LU Chaojing, CHEN Hezhong. Impact of thoracic duct ligation on substance metabolism and surgical complications in patients with type-2 diabetes mellitus during esophagectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(1): 31-38. doi: 10.7507/1007-4848.201907018 Copy

1.	Chen KN. Managing complicationsⅠ: leaks, strictures, emptying, reflux, chylothorax. J Thorac Dis, 2014, 6(Suppl 3): S355-S363.
2.	Miao L, Zhang Y, Hu H, et al. Incidence and management of chylothorax after esophagectomy. Thorac Cancer, 2015, 6(3): 354-358.
3.	Bryant AS, Minnich DJ, Wei B, et al. The incidence and management of postoperative chylothorax after pulmonary resection and thoracic mediastinal lymph node dissection. Ann Thorac Surg, 2014, 98(1): 232-235.
4.	Kranzfelder M, Gertler R, Hapfelmeier A, et al. Chylothorax after esophagectomy for cancer: impact of the surgical approach and neoadjuvant treatment: systematic review and institutional analysis. Surg Endosc, 2013, 27(10): 3530-3538.
5.	Mishra PK, Saluja SS, Ramaswamy D, et al. Thoracic duct injury following esophagectomy in carcinoma of the esophagus: ligation by the abdominal approach. World J Surg, 2013, 37(1): 141-146.
6.	Shah RD, Luketich JD, Schuchert MJ, et al. Postesophagectomy chylothorax: incidence, risk factors, and outcomes. Ann Thorac Surg, 2012, 93(3): 897-903.
7.	Wemyss-Holden SA, Launois B, Maddern GJ. Management of thoracic duct injuries after oesophagectomy. Br J Surg, 2001, 88(11): 1442-1448.
8.	Brinkmann S, Schroeder W, Junggeburth K, et al. Incidence and management of chylothorax after Ivor Lewis esophagectomy for cancer of the esophagus. J Thorac Cardiovasc Surg, 2016, 151(5): 1398-1404.
9.	Fujita T, Daiko H. Efficacy and predictor of octreotide treatment for postoperative chylothorax after thoracic esophagectomy. World J Surg, 2014, 38(8): 2039-2045.
10.	Yamamoto M, Miyata H, Yamasaki M, et al. Chylothorax after esophagectomy cured by intranodal lymphangiography: a case report. Anticancer Res, 2015, 35(2): 891-895.
11.	Aziz WA, Rossaak JI. A unique approach to thoracic duct leak after esophagectomy. Surg Laparosc Endosc Percutan Tech, 2014, 24(4): e155-e156.
12.	Marthaller KJ, Johnson SP, Pride RM, et al. Percutaneous embolization of thoracic duct injury post-esophagectomy should be considered initial treatment for chylothorax before proceeding with open re-exploration. Am J Surg, 2015, 209(2): 235-239.
13.	Cagol M, Ruol A, Castoro C, et al. Prophylactic thoracic duct mass ligation prevents chylothorax after transthoracic esophagectomy for cancer. World J Surg, 2009, 33(8): 1684-1686.
14.	Lai FC, Chen L, Tu YR, et al. Prevention of chylothorax complicating extensive esophageal resection by mass ligation of thoracic duct: a random control study. Ann Thorac Surg, 2011, 91(6): 1770-1774.
15.	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(5): 1332-1336.
16.	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(6): 1019-1024.
17.	Cavriani G, Domingos HV, Oliveira-Filho RM, et al. Lymphatic thoracic duct ligation modulates the serum levels of IL-1beta and IL-10 after intestinal ischemia/reperfusion in rats with the involvement of tumor necrosis factor alpha and nitric oxide. Shock, 2007, 27(2): 209-213.
18.	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(12): 1756-1762.
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(6): 1802-1807.
20.	Yuan Y, Chen LQ, Zhao Y. Anastomosis between thoracic duct and azygos vein during esophagectomy: A novel technique with 3-year follow-up. World J Surg, 2016, 40(12): 2984-2987.
21.	Huynh K, Martins RN, Meikle PJ. Lipidomic profiles in diabetes and dementia. J Alzheimers Dis, 2017, 59(2): 433-444.
22.	Fu JH, Hu Y, Huang WZ, et al. Evaluating prophylactic ligation of thoracic duct during radical resection of esophageal carcinoma. Ai Zheng, 2006, 25(6): 728-730.
23.	Yang R, Jiang Z, Zhang R, et al. Effect of ligation of the thoracic duct during oesophagectomy on the absorption of D-xylose. J Coll Physicians Surg Pak, 2017, 27(3): 153-156.
24.	Liu JP, Zhang YH, Yang B, et al. Influence of thoracic duct ligation on the lipid metabolism of patients with esophageal carcinoma after esophagectomy. Genet Mol Res, 2015, 14(1): 2527-2536.
25.	Cruz NI, Santiago E, Abdul-Hadi A. Prevalence of diabetes mellitus in the surgical population of the university of puerto rico affiliated hospitals: a study using the surgery database. P R Health Sci J, 2016, 35(3): 160-164.
26.	Wright CD, Kucharczuk JC, O’Brien SM, et al. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J Thorac Cardiovasc Surg, 2009, 137(3): 587-595.
27.	Ito N, Iwaya T, Ikeda K, et al. Hyperglycemia 3 days after esophageal cancer surgery is associated with an increased risk of postoperative infection. J Gastrointest Surg, 2014, 18(9): 1547-1556.
28.	Hu Q, Ren J, Li G, et al. Clinical significance of post-operative hyperglycemia in nondiabetic patients undergoing definitive surgery for gastrointestinal fistula. Surg Infect (Larchmt), 2016, 17(4): 491-497.
29.	Bédat B, Scarpa CR, Sadowski SM, et al. Acute pancreatitis after thoracic duct ligation for iatrogenic chylothorax. A case report. BMC Surg, 2017, 17(1): 9.
30.	冯喆, 王兵. 胸导管结扎对食管癌患者术后肝功能的影响. 中华胸心血管外科杂志, 2013, 29(11): 683-684.
31.	Aiko S, Yoshizumi Y, Matsuyama T, et al. Influences of thoracic duct blockage on early enteral nutrition for patients who underwent esophageal cancer surgery. Jpn J Thorac Cardiovasc Surg, 2003, 51(7): 263-271.
32.	Fang W, Kato H, Tachimori Y, et al. Analysis of pulmonary complications after three-field lymph node dissection for esophageal cancer. Ann Thorac Surg, 2003, 76(3): 903-908.
33.	Bakhos CT, Fabian T, Oyasiji TO, et al. Impact of the surgical technique on pulmonary morbidity after esophagectomy. Ann Thorac Surg, 2012, 93(1): 221-226.
34.	Kassis ES, Kosinski AS, Ross P Jr, et al. Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg, 2013, 96(6): 1919-1926.
35.	Okamura A, Watanabe M, Imamura Y, et al. Preoperative glycosylated hemoglobin levels predict anastomotic leak after esophagectomy with cervical esophagogastric anastomosis. World J Surg, 2017, 41(1): 200-207.
36.	Wang YJ, Liu XH, Mei LY, et al. Do alterations in plasma albumin and prealbumin after minimally invasive esophagectomy for squamous cell carcinoma influence the incidence of cervical anastomotic leak? Surg Endosc, 2016, 30(9): 3943-3949.

1. Chen KN. Managing complicationsⅠ: leaks, strictures, emptying, reflux, chylothorax. J Thorac Dis, 2014, 6(Suppl 3): S355-S363.
2. Miao L, Zhang Y, Hu H, et al. Incidence and management of chylothorax after esophagectomy. Thorac Cancer, 2015, 6(3): 354-358.
3. Bryant AS, Minnich DJ, Wei B, et al. The incidence and management of postoperative chylothorax after pulmonary resection and thoracic mediastinal lymph node dissection. Ann Thorac Surg, 2014, 98(1): 232-235.
4. Kranzfelder M, Gertler R, Hapfelmeier A, et al. Chylothorax after esophagectomy for cancer: impact of the surgical approach and neoadjuvant treatment: systematic review and institutional analysis. Surg Endosc, 2013, 27(10): 3530-3538.
5. Mishra PK, Saluja SS, Ramaswamy D, et al. Thoracic duct injury following esophagectomy in carcinoma of the esophagus: ligation by the abdominal approach. World J Surg, 2013, 37(1): 141-146.
6. Shah RD, Luketich JD, Schuchert MJ, et al. Postesophagectomy chylothorax: incidence, risk factors, and outcomes. Ann Thorac Surg, 2012, 93(3): 897-903.
7. Wemyss-Holden SA, Launois B, Maddern GJ. Management of thoracic duct injuries after oesophagectomy. Br J Surg, 2001, 88(11): 1442-1448.
8. Brinkmann S, Schroeder W, Junggeburth K, et al. Incidence and management of chylothorax after Ivor Lewis esophagectomy for cancer of the esophagus. J Thorac Cardiovasc Surg, 2016, 151(5): 1398-1404.
9. Fujita T, Daiko H. Efficacy and predictor of octreotide treatment for postoperative chylothorax after thoracic esophagectomy. World J Surg, 2014, 38(8): 2039-2045.
10. Yamamoto M, Miyata H, Yamasaki M, et al. Chylothorax after esophagectomy cured by intranodal lymphangiography: a case report. Anticancer Res, 2015, 35(2): 891-895.
11. Aziz WA, Rossaak JI. A unique approach to thoracic duct leak after esophagectomy. Surg Laparosc Endosc Percutan Tech, 2014, 24(4): e155-e156.
12. Marthaller KJ, Johnson SP, Pride RM, et al. Percutaneous embolization of thoracic duct injury post-esophagectomy should be considered initial treatment for chylothorax before proceeding with open re-exploration. Am J Surg, 2015, 209(2): 235-239.
13. Cagol M, Ruol A, Castoro C, et al. Prophylactic thoracic duct mass ligation prevents chylothorax after transthoracic esophagectomy for cancer. World J Surg, 2009, 33(8): 1684-1686.
14. Lai FC, Chen L, Tu YR, et al. Prevention of chylothorax complicating extensive esophageal resection by mass ligation of thoracic duct: a random control study. Ann Thorac Surg, 2011, 91(6): 1770-1774.
15. 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(5): 1332-1336.
16. 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(6): 1019-1024.
17. Cavriani G, Domingos HV, Oliveira-Filho RM, et al. Lymphatic thoracic duct ligation modulates the serum levels of IL-1beta and IL-10 after intestinal ischemia/reperfusion in rats with the involvement of tumor necrosis factor alpha and nitric oxide. Shock, 2007, 27(2): 209-213.
18. 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(12): 1756-1762.
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(6): 1802-1807.
20. Yuan Y, Chen LQ, Zhao Y. Anastomosis between thoracic duct and azygos vein during esophagectomy: A novel technique with 3-year follow-up. World J Surg, 2016, 40(12): 2984-2987.
21. Huynh K, Martins RN, Meikle PJ. Lipidomic profiles in diabetes and dementia. J Alzheimers Dis, 2017, 59(2): 433-444.
22. Fu JH, Hu Y, Huang WZ, et al. Evaluating prophylactic ligation of thoracic duct during radical resection of esophageal carcinoma. Ai Zheng, 2006, 25(6): 728-730.
23. Yang R, Jiang Z, Zhang R, et al. Effect of ligation of the thoracic duct during oesophagectomy on the absorption of D-xylose. J Coll Physicians Surg Pak, 2017, 27(3): 153-156.
24. Liu JP, Zhang YH, Yang B, et al. Influence of thoracic duct ligation on the lipid metabolism of patients with esophageal carcinoma after esophagectomy. Genet Mol Res, 2015, 14(1): 2527-2536.
25. Cruz NI, Santiago E, Abdul-Hadi A. Prevalence of diabetes mellitus in the surgical population of the university of puerto rico affiliated hospitals: a study using the surgery database. P R Health Sci J, 2016, 35(3): 160-164.
26. Wright CD, Kucharczuk JC, O’Brien SM, et al. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J Thorac Cardiovasc Surg, 2009, 137(3): 587-595.
27. Ito N, Iwaya T, Ikeda K, et al. Hyperglycemia 3 days after esophageal cancer surgery is associated with an increased risk of postoperative infection. J Gastrointest Surg, 2014, 18(9): 1547-1556.
28. Hu Q, Ren J, Li G, et al. Clinical significance of post-operative hyperglycemia in nondiabetic patients undergoing definitive surgery for gastrointestinal fistula. Surg Infect (Larchmt), 2016, 17(4): 491-497.
29. Bédat B, Scarpa CR, Sadowski SM, et al. Acute pancreatitis after thoracic duct ligation for iatrogenic chylothorax. A case report. BMC Surg, 2017, 17(1): 9.
30. 冯喆, 王兵. 胸导管结扎对食管癌患者术后肝功能的影响. 中华胸心血管外科杂志, 2013, 29(11): 683-684.
31. Aiko S, Yoshizumi Y, Matsuyama T, et al. Influences of thoracic duct blockage on early enteral nutrition for patients who underwent esophageal cancer surgery. Jpn J Thorac Cardiovasc Surg, 2003, 51(7): 263-271.
32. Fang W, Kato H, Tachimori Y, et al. Analysis of pulmonary complications after three-field lymph node dissection for esophageal cancer. Ann Thorac Surg, 2003, 76(3): 903-908.
33. Bakhos CT, Fabian T, Oyasiji TO, et al. Impact of the surgical technique on pulmonary morbidity after esophagectomy. Ann Thorac Surg, 2012, 93(1): 221-226.
34. Kassis ES, Kosinski AS, Ross P Jr, et al. Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg, 2013, 96(6): 1919-1926.
35. Okamura A, Watanabe M, Imamura Y, et al. Preoperative glycosylated hemoglobin levels predict anastomotic leak after esophagectomy with cervical esophagogastric anastomosis. World J Surg, 2017, 41(1): 200-207.
36. Wang YJ, Liu XH, Mei LY, et al. Do alterations in plasma albumin and prealbumin after minimally invasive esophagectomy for squamous cell carcinoma influence the incidence of cervical anastomotic leak? Surg Endosc, 2016, 30(9): 3943-3949.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Impact of thoracic duct ligation on substance metabolism and surgical complications in patients with type-2 diabetes mellitus during esophagectomy

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