Thoracic duct ligation during esophagectomy fails to prevent chylothorax or improve survival: a propensity score matched cohort study.

BACKGROUND

Postoperative chylothorax is a serious complication following esophagectomy. The efficacy of thoracic duct ligation (TDL) for chylothorax prevention is controversial. This study aimed to evaluate the impact of TDL on chylothorax prevention, postoperative biochemical changes, and overall survival (OS) in esophageal cancer patients.

METHODS

We conducted a retrospective cohort study including 991 patients who underwent esophagectomy for esophageal cancer(May 2017-May 2020), stratified into TDL (n = 286) and non-TDL (n = 705) groups. Propensity score matching (PSM) was employed to minimize selection bias(252 pairs matched). Primary endpoints included chylothorax incidence, postoperative biochemical markers, and 5-year OS.

RESULTS

TDL did not reduce the incidence of chylothorax (1.2% vs. 1.2%, P = 1.000). It significantly decreased serum protein levels (postoperative ALB 31.8 vs. 32.5 g/L, P= 0.047), while liver enzymes and bilirubin remained unaffected. No survival benefit was observed (5-year OS 42% vs. 45%, P = 0.49).

CONCLUSION

After excluding invasion cases and balancing measurable confounders, TDL was not associated with a lower incidence of chylothorax or improved long-term survival.