The efficacy of thoracic duct ligation for post-esophagectomy chylothorax in esophageal cancer: a nationwide inpatient cohort study.

BACKGROUND

Recently, thoracic duct embolization (TDE) has been increasingly adopted as a first-line minimally invasive therapy for post-esophagectomy chylothorax instead of thoracoscopic thoracic duct ligation (TTDL). However, the therapeutic efficacy and advantages of TDE over TTDL are still controversial. This study aimed to evaluate and compare the clinical and financial outcomes of TDE and TTDL for post-operative chylothorax after esophagectomy using a national database.

METHODS

We retrieved data from patients with esophageal cancer who underwent TDE (n = 312) or TTDL (n = 167) for chylothorax after esophagectomy between April 2012 and March 2022 from the Diagnosis Procedure Combination database in Japan. We compared the success rate of the first intervention, length of post-interventional hospital stay, and total hospitalization cost between the TDE and TTDL groups using propensity score matching analysis.

RESULTS

The success rate of the first intervention was significantly higher in the TTDL group than in the TDE group (odds ratio, 6.13; 95 % confidence interval [CI], 3.25 to 11.55). The length of post-interventional hospital stay was significantly shorter (regression coefficient, -14.8 days; 95 % CI, -26.7 to -2.9) and the total hospitalization cost was significantly lower in the TTDL group than in the TDE group (regression coefficient, -1,258,212 yen; 95 % CI, -2,082,407 to -434,017).

CONCLUSIONS

This nationwide cohort study showed that TTDL was associated with a shorter length of post-interventional hospital stay, lower total hospitalization cost, and higher success rate of the first intervention than TDE for post-esophagectomy chylothorax.