Background/Objectives: The effect of thoracic duct (TD) management—resection, ligation, or preservation—during esophagectomy for cancer remains controversial. This systematic review and meta-analysis aimed to assess the impact of TD management strategies on oncological outcomes and surgical morbidity. Methods: A systematic review and meta-analysis were performed following PRISMA reporting guidelines. Searches of OVID, Embase, and Web of Science identified studies comparing thoracic duct resection or TD ligation with TD preservation in esophagectomy for cancer. Outcomes included 5-year overall survival (OS), postoperative morbidity, postoperative chyle leakage, lymph node yield, and length of stay. Random-effects meta-analyses using the Hartung-Knapp-Sidik-Jonkman variance correction were conducted. Results: A total of 17 studies involving 4200 patients were included. TD resection was associated with a significantly higher lymph node yield (mean difference [MD]: 4, 95% CI: 0 to 8,p= 0.043), but also increased risk of chyle leakage (odds ratio [OR]: 2.41, 95% CI: 1.04–5.61,p= 0.044). There was no significant improvement in 5-year OS with TD resection compared to TD preservation (hazard ratio [HR]: 0.94, 95% CI: 0.76–1.17,p= 0.48). TD ligation showed no significant differences in 5-year OS (HR: 1.15, 95% CI: 0.81–1.63,p= 0.33) or morbidity compared to TD preservation. Certainty of evidence was low across outcomes. Conclusions: TD resection increases lymph node yield but is associated with higher rates of chyle leakage, without a significantly improved overall survival. TD ligation does not significantly affect oncological or surgical outcomes compared to TD preservation. A higher grade of evidence is needed to determine the definitive oncological and surgical impact of TD management strategies.
背景/目的：在食管癌切除术中，胸导管（TD）的处理方式——切除、结扎或保留——其效果仍存在争议。本系统综述和荟萃分析旨在评估胸导管处理策略对肿瘤学结局和手术并发症的影响。方法：按照PRISMA报告指南进行了系统综述和荟萃分析。通过检索OVID、Embase和Web of Science，识别出在食管癌切除术中比较胸导管切除或胸导管结扎与胸导管保留的研究。结局指标包括5年总生存期（OS）、术后并发症、术后乳糜漏、淋巴结获取数量以及住院时间。采用Hartung-Knapp-Sidik-Jonkman方差校正进行了随机效应荟萃分析。结果：共纳入17项研究，涉及4200名患者。胸导管切除与显著更高的淋巴结获取数量相关（平均差[MD]: 4, 95% CI: 0 至 8, p=0.043），但也增加了乳糜漏的风险（比值比[OR]: 2.41, 95% CI: 1.04–5.61, p=0.044）。与胸导管保留相比，胸导管切除并未显著改善5年总生存期（风险比[HR]: 0.94, 95% CI: 0.76–1.17, p=0.48）。与胸导管保留相比，胸导管结扎在5年总生存期（HR: 1.15, 95% CI: 0.81–1.63, p=0.33）或并发症方面均未显示出显著差异。各项结局的证据质量均为低等级。结论：胸导管切除可增加淋巴结获取数量，但与更高的乳糜漏发生率相关，且未显著改善总生存期。与胸导管保留相比，胸导管结扎对肿瘤学或手术结局无显著影响。需要更高质量的证据来确定胸导管处理策略对肿瘤学和手术结局的确切影响。
肿瘤(癌症)患者之家