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.	劉迎軍. 食管癌術后乳糜胸發生的原因與預防策略的臨床研究. 中國實用醫藥, 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.	丁云禮, 易德發, 劉木堯, 等. 胸導管結扎術預防食管癌根治術后乳糜胸的效果分析. 吉林醫學, 2014, 35(4):751.
7.	萬富芳. 預防性胸導管結扎術對預防乳糜胸的作用及其對并發癥和預后的影響分析. 中國處方藥, 2015, 13(12):114-115.
8.	嚴華, 付向寧, 湯應雄, 等. 膈上胸導管結扎術在食管癌切除術中的應用. 臨床外科雜志, 2011, 19(2):115-117.
9.	傅俊惠, 鄭海波, 楊逸峰,等. 不同方法結扎胸導管預防食管癌術后乳糜胸. 臨床外科雜志, 2004, 12(2):127-128.
10.	傅劍華, 胡袆, 黃偉釗,等. 預防性胸導管結扎術在食管癌根治術中的價值. 中國首屆國際食管癌學術會議暨第七屆全國食管癌學術會議論文集. 2005:216-219.
11.	葉曉鋒,高平,葛箭, 等. 食管癌術中常規低位結扎胸導管對預防術后乳糜胸的臨床觀察.寧夏醫學雜志, 2007, 29(4):349-350.
12.	孫超, 石維平, 束余聲, 等. 低位胸導管結扎在預防食管癌切除術后乳糜胸的應用. 臨床外科雜志, 2013, 21(3):195-196.
13.	張合明. 食管癌術中結扎胸導管預防乳糜胸的研究. 醫藥論壇雜志, 2011(13):169-170.
14.	彭品賢, 謝遠財, 梁建輝, 等. 胸導管結扎防止食管癌術后乳糜胸的發生. 世界華人消化雜志, 2001, 9(3):360.
15.	徐啟良. 胸導管結扎預防食管癌術后乳糜胸. 實用醫學雜志, 2005, 21(12):1334-1335.
16.	戶安喜, 王斌, 閻新麗, 等. 食管癌術中預扎胸導管防治乳糜胸應用評價. 中外健康文摘, 2011, 8(28):8-9.
17.	朱乾坤, 吳小波. 食管癌術中胸導管結扎預防乳糜胸-隨機對照試驗. 中國醫學裝備, 2014, 11(B12):59-59.
18.	李忠望, 李洪林, 徐勉, 等. 低位結扎胸導管預防食管癌術后乳糜胸. 中國基層醫藥, 2010, 17(12):1649-1650.
19.	李振龍. 食道癌術中結扎胸導管預防乳糜胸. 菏澤醫學專科學校學報, 2004, 16(4):29-30.
20.	柴惠平, 劉曉, 葛建軍, 等. 胸導管結扎預防食管癌術后乳糜胸的臨床研究. 安徽醫科大學學報, 2000, 35(3):208-211.
21.	武鐵軍, 魏曉麗. 結扎胸導管在食管癌手術中的應用研究. 中國醫學創新, 2010, 7(15):63-64.
22.	鐘釧, 龔晟, 張永恒, 等. 膈上結扎胸導管對預防食管癌術后乳糜胸的臨床研究. 中國醫藥指南, 2013(3):164-165.
23.	陳光成, 管宏俊, 楊志剛, 等. 食管癌術中結扎胸導管預防乳糜胸的臨床體會. 牡丹江醫學院學報, 2013(1):46-48.
24.	靳鈺, 莊建軍. 胸導管結扎術預防食管癌術后乳糜胸的療效觀察. 江蘇醫藥, 1997, 23(9):637-638.
25.	黎超偉. 低位集束結扎胸導管在預防食管癌切除術后乳糜胸的研究. 中國現代醫生, 2009, 47(20):34-35.
26.	邵令方, 張毓德. 食管外科學. 第一版. 石家莊:河北科學技術出版社出版社, 1987:11.
27.	Cerfolio RJ. Chylothorax after esophagogastrectomy. Thorac Surg Clin, 2006, 16(1):49-52.
28.	陳倫元, 陳錫樹, 李波, 等. 預防性胸導管結扎與乳糜胸. 臨床和實驗醫學雜志, 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.	武鐵軍, 陳新, 何明, 等. 結扎胸導管對食管癌術后腸道細菌內毒素移位的研究. 河北醫藥, 2010, 32(12):1577-1579.
31.	武鐵軍, 陳新, 何明, 等. 結扎胸導管對食管癌術后患者生命體征影響的研究. 中國醫學創新, 2010, 7(11):15-17.
32.	周福有, 馬金山. 616例食管癌術中常規胸導管結扎結果評價. 中國腫瘤臨床, 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, 耿明飛, 等. 胸導管結扎對食管癌術后早期腸內營養支持的影響. 中國衛生產業, 2014 (1):160-161.
36.	李洪濤, 郭偉, 張珂, 等. 食管癌術前口服脂肪乳劑預防術后乳糜胸研究. 中華全科醫學, 2009, 7(7):683-684.
37.	傅劍華, 胡袆, 黃偉釗, 等. 預防性胸導管結扎術在食管癌根治術中應用的評價. 癌癥, 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. 劉迎軍. 食管癌術后乳糜胸發生的原因與預防策略的臨床研究. 中國實用醫藥, 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. 丁云禮, 易德發, 劉木堯, 等. 胸導管結扎術預防食管癌根治術后乳糜胸的效果分析. 吉林醫學, 2014, 35(4):751.
7. 萬富芳. 預防性胸導管結扎術對預防乳糜胸的作用及其對并發癥和預后的影響分析. 中國處方藥, 2015, 13(12):114-115.
8. 嚴華, 付向寧, 湯應雄, 等. 膈上胸導管結扎術在食管癌切除術中的應用. 臨床外科雜志, 2011, 19(2):115-117.
9. 傅俊惠, 鄭海波, 楊逸峰,等. 不同方法結扎胸導管預防食管癌術后乳糜胸. 臨床外科雜志, 2004, 12(2):127-128.
10. 傅劍華, 胡袆, 黃偉釗,等. 預防性胸導管結扎術在食管癌根治術中的價值. 中國首屆國際食管癌學術會議暨第七屆全國食管癌學術會議論文集. 2005:216-219.
11. 葉曉鋒,高平,葛箭, 等. 食管癌術中常規低位結扎胸導管對預防術后乳糜胸的臨床觀察.寧夏醫學雜志, 2007, 29(4):349-350.
12. 孫超, 石維平, 束余聲, 等. 低位胸導管結扎在預防食管癌切除術后乳糜胸的應用. 臨床外科雜志, 2013, 21(3):195-196.
13. 張合明. 食管癌術中結扎胸導管預防乳糜胸的研究. 醫藥論壇雜志, 2011(13):169-170.
14. 彭品賢, 謝遠財, 梁建輝, 等. 胸導管結扎防止食管癌術后乳糜胸的發生. 世界華人消化雜志, 2001, 9(3):360.
15. 徐啟良. 胸導管結扎預防食管癌術后乳糜胸. 實用醫學雜志, 2005, 21(12):1334-1335.
16. 戶安喜, 王斌, 閻新麗, 等. 食管癌術中預扎胸導管防治乳糜胸應用評價. 中外健康文摘, 2011, 8(28):8-9.
17. 朱乾坤, 吳小波. 食管癌術中胸導管結扎預防乳糜胸-隨機對照試驗. 中國醫學裝備, 2014, 11(B12):59-59.
18. 李忠望, 李洪林, 徐勉, 等. 低位結扎胸導管預防食管癌術后乳糜胸. 中國基層醫藥, 2010, 17(12):1649-1650.
19. 李振龍. 食道癌術中結扎胸導管預防乳糜胸. 菏澤醫學專科學校學報, 2004, 16(4):29-30.
20. 柴惠平, 劉曉, 葛建軍, 等. 胸導管結扎預防食管癌術后乳糜胸的臨床研究. 安徽醫科大學學報, 2000, 35(3):208-211.
21. 武鐵軍, 魏曉麗. 結扎胸導管在食管癌手術中的應用研究. 中國醫學創新, 2010, 7(15):63-64.
22. 鐘釧, 龔晟, 張永恒, 等. 膈上結扎胸導管對預防食管癌術后乳糜胸的臨床研究. 中國醫藥指南, 2013(3):164-165.
23. 陳光成, 管宏俊, 楊志剛, 等. 食管癌術中結扎胸導管預防乳糜胸的臨床體會. 牡丹江醫學院學報, 2013(1):46-48.
24. 靳鈺, 莊建軍. 胸導管結扎術預防食管癌術后乳糜胸的療效觀察. 江蘇醫藥, 1997, 23(9):637-638.
25. 黎超偉. 低位集束結扎胸導管在預防食管癌切除術后乳糜胸的研究. 中國現代醫生, 2009, 47(20):34-35.
26. 邵令方, 張毓德. 食管外科學. 第一版. 石家莊:河北科學技術出版社出版社, 1987:11.
27. Cerfolio RJ. Chylothorax after esophagogastrectomy. Thorac Surg Clin, 2006, 16(1):49-52.
28. 陳倫元, 陳錫樹, 李波, 等. 預防性胸導管結扎與乳糜胸. 臨床和實驗醫學雜志, 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. 武鐵軍, 陳新, 何明, 等. 結扎胸導管對食管癌術后腸道細菌內毒素移位的研究. 河北醫藥, 2010, 32(12):1577-1579.
31. 武鐵軍, 陳新, 何明, 等. 結扎胸導管對食管癌術后患者生命體征影響的研究. 中國醫學創新, 2010, 7(11):15-17.
32. 周福有, 馬金山. 616例食管癌術中常規胸導管結扎結果評價. 中國腫瘤臨床, 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, 耿明飛, 等. 胸導管結扎對食管癌術后早期腸內營養支持的影響. 中國衛生產業, 2014 (1):160-161.
36. 李洪濤, 郭偉, 張珂, 等. 食管癌術前口服脂肪乳劑預防術后乳糜胸研究. 中華全科醫學, 2009, 7(7):683-684.
37. 傅劍華, 胡袆, 黃偉釗, 等. 預防性胸導管結扎術在食管癌根治術中應用的評價. 癌癥, 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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