Comparison of Different Surgical Thoracic Duct Management on Prevention of Postoperative Chylothorax for Esophagectomy: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 KawulJuma , JuratAnwar , IdrisAwut ,  IlyarSheyhidin

Department of Thoracic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China;

Corresponding author：

IlyarSheyhidin, Email: ilyarsha@sina.com

Keywords：

Esophagectomy; Chylothorax; Thoracic duct ligation; Meta-analysis

DOI：

10.7507/1672-2531.20160217

Video：

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Objectives To compare the clinical efficacy of different surgical thoracic duct management on prevention of postoperative chylothorax and its impact on the outcome of the patients. Methods We searched the electronic databases including PubMed, The Cochrane Library (Issue 4, 2016), Web of Science, CBM, CNKI, VIP and WanFang Data to collect randomized controlled trials (RCTs), cohort studies and case-control studies related to the comparison of different surgical thoracic duct management during esophagectomy on prevention of postoperative chylothorax from inception to May 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then RevMan 5.2 software was used for meta-analysis. Results Twenty-three trials were included, involving four RCTs, four cohort studies and 15 case-control studies. The results of meta-analysis indicated:(1) Prophylactic thoracic duct ligation group had lower incidence of postoperative chylothorax compared with non thoracoic duct ligation group (RCT:OR=0.20, 95%CI 0.09 to 0.47, P=0.000 02; Co/CC:OR=0.20, 95%CI 0.14 to 0.28, P<0.000 01); (2) There were no significant differences between the two groups in the respect of mortality, morbidity and the 2-year, 3-year, 5-year survival rates (all P values >0.05); (3) Prophylactic thoracic duct ligation could reduce the reoperation rate of chylothorax complicating esophageal cancer patients (RCT:OR=0.17, 95%CI 0.10 to 0.28, P<0.000 01; Co/CC:OR=0.18, 95%CI to 0.11 to 0.32, P<0.000 01), and increase the cure rate of expectant treatment on them (OR=0.25, 95%CI 0.11 to 0.56, P=0.000 8); (4) En bloc thoracic duct ligation group had a lower incidence of postoperative chylothorax compared with single thoracic duct ligation group (OR=3.67, 95%CI 1.43 to 9.43, P=0.007). Conclusion Prophylactic thoracic duct ligation during esophagectomy could effectively reduce the incidence of postoperative chylothorax and is good for reducing the reoperation rate of chylothorax complicating esophageal cancer patients. En bloc thoracic duct ligation has a better efficacy on prevention of postoperative chylothorax compared with single thoracic duct ligation.

Citation： KawulJuma, JuratAnwar, IdrisAwut, IlyarSheyhidin. Comparison of Different Surgical Thoracic Duct Management on Prevention of Postoperative Chylothorax for Esophagectomy: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(12): 1443-1453. doi: 10.7507/1672-2531.20160217 Copy

1.	刘迎军. 食管癌术后乳糜胸发生的原因与预防策略的临床研究. 中国实用医药, 2013, 8(15):101-102.
2.	Merigliano S, Molena D, Ruol A, et al. Chylothorax complicating esophagectomy for cancer:a plea for early thoracic duct ligation. J Thorac Cardiovasc Surg, 2000, 119(3):453-457.
3.	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.
4.	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.
5.	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.
6.	丁云礼, 易德发, 刘木尧, 等. 胸导管结扎术预防食管癌根治术后乳糜胸的效果分析. 吉林医学, 2014, 35(4):751.
7.	万富芳. 预防性胸导管结扎术对预防乳糜胸的作用及其对并发症和预后的影响分析. 中国处方药, 2015, 13(12):114-115.
8.	严华, 付向宁, 汤应雄, 等. 膈上胸导管结扎术在食管癌切除术中的应用. 临床外科杂志, 2011, 19(2):115-117.
9.	傅俊惠, 郑海波, 杨逸峰,等. 不同方法结扎胸导管预防食管癌术后乳糜胸. 临床外科杂志, 2004, 12(2):127-128.
10.	傅剑华, 胡袆, 黄伟钊,等. 预防性胸导管结扎术在食管癌根治术中的价值. 中国首届国际食管癌学术会议暨第七届全国食管癌学术会议论文集. 2005:216-219.
11.	叶晓锋,高平,葛箭, 等. 食管癌术中常规低位结扎胸导管对预防术后乳糜胸的临床观察.宁夏医学杂志, 2007, 29(4):349-350.
12.	孙超, 石维平, 束余声, 等. 低位胸导管结扎在预防食管癌切除术后乳糜胸的应用. 临床外科杂志, 2013, 21(3):195-196.
13.	张合明. 食管癌术中结扎胸导管预防乳糜胸的研究. 医药论坛杂志, 2011(13):169-170.
14.	彭品贤, 谢远财, 梁建辉, 等. 胸导管结扎防止食管癌术后乳糜胸的发生. 世界华人消化杂志, 2001, 9(3):360.
15.	徐启良. 胸导管结扎预防食管癌术后乳糜胸. 实用医学杂志, 2005, 21(12):1334-1335.
16.	户安喜, 王斌, 阎新丽, 等. 食管癌术中预扎胸导管防治乳糜胸应用评价. 中外健康文摘, 2011, 8(28):8-9.
17.	朱乾坤, 吴小波. 食管癌术中胸导管结扎预防乳糜胸-随机对照试验. 中国医学装备, 2014, 11(B12):59-59.
18.	李忠望, 李洪林, 徐勉, 等. 低位结扎胸导管预防食管癌术后乳糜胸. 中国基层医药, 2010, 17(12):1649-1650.
19.	李振龙. 食道癌术中结扎胸导管预防乳糜胸. 菏泽医学专科学校学报, 2004, 16(4):29-30.
20.	柴惠平, 刘晓, 葛建军, 等. 胸导管结扎预防食管癌术后乳糜胸的临床研究. 安徽医科大学学报, 2000, 35(3):208-211.
21.	武铁军, 魏晓丽. 结扎胸导管在食管癌手术中的应用研究. 中国医学创新, 2010, 7(15):63-64.
22.	钟钏, 龚晟, 张永恒, 等. 膈上结扎胸导管对预防食管癌术后乳糜胸的临床研究. 中国医药指南, 2013(3):164-165.
23.	陈光成, 管宏俊, 杨志刚, 等. 食管癌术中结扎胸导管预防乳糜胸的临床体会. 牡丹江医学院学报, 2013(1):46-48.
24.	靳钰, 庄建军. 胸导管结扎术预防食管癌术后乳糜胸的疗效观察. 江苏医药, 1997, 23(9):637-638.
25.	黎超伟. 低位集束结扎胸导管在预防食管癌切除术后乳糜胸的研究. 中国现代医生, 2009, 47(20):34-35.
26.	邵令方, 张毓德. 食管外科学. 第一版. 石家庄:河北科学技术出版社出版社, 1987:11.
27.	Cerfolio RJ. Chylothorax after esophagogastrectomy. Thorac Surg Clin, 2006, 16(1):49-52.
28.	陈伦元, 陈锡树, 李波, 等. 预防性胸导管结扎与乳糜胸. 临床和实验医学杂志, 2010, 9(5):335-336, 338.
29.	Sokouti M, Montazeri V. Results of prophylactic thoracic duct ligation in advanced esophageal carcinoma. Indian J Thorac Cardiovasc Surg, 2009, 25(1):18-22.
30.	武铁军, 陈新, 何明, 等. 结扎胸导管对食管癌术后肠道细菌内毒素移位的研究. 河北医药, 2010, 32(12):1577-1579.
31.	武铁军, 陈新, 何明, 等. 结扎胸导管对食管癌术后患者生命体征影响的研究. 中国医学创新, 2010, 7(11):15-17.
32.	周福有, 马金山. 616例食管癌术中常规胸导管结扎结果评价. 中国肿瘤临床, 1996, 23(2):97-99.
33.	Fahimi H, Casselman FP, Mariani MA, et al. Current management of postoperative chylothorax. Ann Thorac Surg, 2001, 71(2):448-450.
34.	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.
35.	史可峰, 周福有, 耿明飞, 等. 胸导管结扎对食管癌术后早期肠内营养支持的影响. 中国卫生产业, 2014 (1):160-161.
36.	李洪涛, 郭伟, 张珂, 等. 食管癌术前口服脂肪乳剂预防术后乳糜胸研究. 中华全科医学, 2009, 7(7):683-684.
37.	傅剑华, 胡袆, 黄伟钊, 等. 预防性胸导管结扎术在食管癌根治术中应用的评价. 癌症, 2006, 25(6):728-730.
38.	Yuan Y, Chen LQ, Zhao Y, et al. Anastomosis between thoracic duct and azygos vein during esophagectomy:a novel technique with 3-year follow up. World J Sur, 2016, 40(12):2984-2987.

1. 刘迎军. 食管癌术后乳糜胸发生的原因与预防策略的临床研究. 中国实用医药, 2013, 8(15):101-102.
2. Merigliano S, Molena D, Ruol A, et al. Chylothorax complicating esophagectomy for cancer:a plea for early thoracic duct ligation. J Thorac Cardiovasc Surg, 2000, 119(3):453-457.
3. 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.
4. 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.
5. 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.
6. 丁云礼, 易德发, 刘木尧, 等. 胸导管结扎术预防食管癌根治术后乳糜胸的效果分析. 吉林医学, 2014, 35(4):751.
7. 万富芳. 预防性胸导管结扎术对预防乳糜胸的作用及其对并发症和预后的影响分析. 中国处方药, 2015, 13(12):114-115.
8. 严华, 付向宁, 汤应雄, 等. 膈上胸导管结扎术在食管癌切除术中的应用. 临床外科杂志, 2011, 19(2):115-117.
9. 傅俊惠, 郑海波, 杨逸峰,等. 不同方法结扎胸导管预防食管癌术后乳糜胸. 临床外科杂志, 2004, 12(2):127-128.
10. 傅剑华, 胡袆, 黄伟钊,等. 预防性胸导管结扎术在食管癌根治术中的价值. 中国首届国际食管癌学术会议暨第七届全国食管癌学术会议论文集. 2005:216-219.
11. 叶晓锋,高平,葛箭, 等. 食管癌术中常规低位结扎胸导管对预防术后乳糜胸的临床观察.宁夏医学杂志, 2007, 29(4):349-350.
12. 孙超, 石维平, 束余声, 等. 低位胸导管结扎在预防食管癌切除术后乳糜胸的应用. 临床外科杂志, 2013, 21(3):195-196.
13. 张合明. 食管癌术中结扎胸导管预防乳糜胸的研究. 医药论坛杂志, 2011(13):169-170.
14. 彭品贤, 谢远财, 梁建辉, 等. 胸导管结扎防止食管癌术后乳糜胸的发生. 世界华人消化杂志, 2001, 9(3):360.
15. 徐启良. 胸导管结扎预防食管癌术后乳糜胸. 实用医学杂志, 2005, 21(12):1334-1335.
16. 户安喜, 王斌, 阎新丽, 等. 食管癌术中预扎胸导管防治乳糜胸应用评价. 中外健康文摘, 2011, 8(28):8-9.
17. 朱乾坤, 吴小波. 食管癌术中胸导管结扎预防乳糜胸-随机对照试验. 中国医学装备, 2014, 11(B12):59-59.
18. 李忠望, 李洪林, 徐勉, 等. 低位结扎胸导管预防食管癌术后乳糜胸. 中国基层医药, 2010, 17(12):1649-1650.
19. 李振龙. 食道癌术中结扎胸导管预防乳糜胸. 菏泽医学专科学校学报, 2004, 16(4):29-30.
20. 柴惠平, 刘晓, 葛建军, 等. 胸导管结扎预防食管癌术后乳糜胸的临床研究. 安徽医科大学学报, 2000, 35(3):208-211.
21. 武铁军, 魏晓丽. 结扎胸导管在食管癌手术中的应用研究. 中国医学创新, 2010, 7(15):63-64.
22. 钟钏, 龚晟, 张永恒, 等. 膈上结扎胸导管对预防食管癌术后乳糜胸的临床研究. 中国医药指南, 2013(3):164-165.
23. 陈光成, 管宏俊, 杨志刚, 等. 食管癌术中结扎胸导管预防乳糜胸的临床体会. 牡丹江医学院学报, 2013(1):46-48.
24. 靳钰, 庄建军. 胸导管结扎术预防食管癌术后乳糜胸的疗效观察. 江苏医药, 1997, 23(9):637-638.
25. 黎超伟. 低位集束结扎胸导管在预防食管癌切除术后乳糜胸的研究. 中国现代医生, 2009, 47(20):34-35.
26. 邵令方, 张毓德. 食管外科学. 第一版. 石家庄:河北科学技术出版社出版社, 1987:11.
27. Cerfolio RJ. Chylothorax after esophagogastrectomy. Thorac Surg Clin, 2006, 16(1):49-52.
28. 陈伦元, 陈锡树, 李波, 等. 预防性胸导管结扎与乳糜胸. 临床和实验医学杂志, 2010, 9(5):335-336, 338.
29. Sokouti M, Montazeri V. Results of prophylactic thoracic duct ligation in advanced esophageal carcinoma. Indian J Thorac Cardiovasc Surg, 2009, 25(1):18-22.
30. 武铁军, 陈新, 何明, 等. 结扎胸导管对食管癌术后肠道细菌内毒素移位的研究. 河北医药, 2010, 32(12):1577-1579.
31. 武铁军, 陈新, 何明, 等. 结扎胸导管对食管癌术后患者生命体征影响的研究. 中国医学创新, 2010, 7(11):15-17.
32. 周福有, 马金山. 616例食管癌术中常规胸导管结扎结果评价. 中国肿瘤临床, 1996, 23(2):97-99.
33. Fahimi H, Casselman FP, Mariani MA, et al. Current management of postoperative chylothorax. Ann Thorac Surg, 2001, 71(2):448-450.
34. 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.
35. 史可峰, 周福有, 耿明飞, 等. 胸导管结扎对食管癌术后早期肠内营养支持的影响. 中国卫生产业, 2014 (1):160-161.
36. 李洪涛, 郭伟, 张珂, 等. 食管癌术前口服脂肪乳剂预防术后乳糜胸研究. 中华全科医学, 2009, 7(7):683-684.
37. 傅剑华, 胡袆, 黄伟钊, 等. 预防性胸导管结扎术在食管癌根治术中应用的评价. 癌症, 2006, 25(6):728-730.
38. Yuan Y, Chen LQ, Zhao Y, et al. Anastomosis between thoracic duct and azygos vein during esophagectomy:a novel technique with 3-year follow up. World J Sur, 2016, 40(12):2984-2987.

Chinese Journal of Evidence-Based Medicine

Comparison of Different Surgical Thoracic Duct Management on Prevention of Postoperative Chylothorax for Esophagectomy: A Meta-analysis

Abstract Full text Figures/Tables Video References Cited by

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