Impact of prophylactic thoracic duct obliteration on chylothorax rates in patients undergoing oesophagectomy: A systematic review and meta-analysis

Lee S Kyang; Simeng Li; Andrew Tse; Douglas Fenton-Lee

doi:10.1016/j.ejso.2025.110197

Impact of prophylactic thoracic duct obliteration on chylothorax rates in patients undergoing oesophagectomy: A systematic review and meta-analysis

Eur J Surg Oncol. 2025 Jun 1;51(9):110197. doi: 10.1016/j.ejso.2025.110197. Online ahead of print.

Authors

Lee S Kyang¹, Simeng Li², Andrew Tse³, Douglas Fenton-Lee¹

Affiliations

¹ St Vincent's Clinical School, University of New South Wales, NSW, 2010, Australia.
² School of Medicine, The University of Notre Dame Australia, NSW, 2010, Australia.
³ St Vincent's Clinical School, University of New South Wales, NSW, 2010, Australia. Electronic address: andrew.tse@health.nsw.gov.au.

PMID: 40466403
DOI: 10.1016/j.ejso.2025.110197

Abstract

Background: Chylothorax after oesophagectomy occurs in up to 8.9 % of cases, resulting in significant morbidity, such as, malnutrition, respiratory distress, and immunosuppression. Prophylactic thoracic duct obliteration through ligation (TDL) or resection (TDR) is proposed to reduce the incidence of chylothorax. However, the impact of these procedures on chylothorax incidence and long-term survival outcomes remain unclear.

Methods: The study protocol was registered at PROSPERO (registration number: CRD42025643054). A systematic review and meta-analysis of 18 studies (12,651 patients) was conducted. The primary outcome was the incidence of chylothorax; secondary outcomes included reoperation rates, postoperative mortality, 5-year survival, and length of hospital stay.

Results: TDR increased the incidence of chylothorax (RR 2.63; 95 %CI, 1.07-6.44, p = 0.04). No significant differences were found in reoperation rates, mortality, or length of hospital stay. There was no impact on 5-year overall survival (HR 0.96; 95 %CI 0.90-1.02, I² = 33 %; p = 0.17).

Conclusions: Prophylactic thoracic duct obliteration, particularly TDR, may increase chylothorax incidence but does not affect long-term survival or other postoperative outcomes.

Keywords: Chylothorax; Oesophageal cancer; Oesophagectomy; Thoracic duct.

Publication types

Review