Ligation of thoracic duct during thoracoscopic esophagectomy can lead to decrease of T lymphocyte.

Area of Science:

• Surgical Oncology
• Immunology
• Thoracic Surgery

Background:

• Video-assisted thoracoscopic esophagectomy is preferred for early esophageal cancer.
• Debate exists on routine thoracic duct ligation to prevent chylothorax.
• T lymphocyte subsets can assess immune effects of prophylactic ligation.

Purpose of the Study:

• To evaluate the impact of prophylactic thoracic duct ligation on T lymphocyte subsets during thoracoscopic esophagectomy.
• To determine if routine ligation affects immune markers post-surgery.

Main Methods:

• 60 patients were randomized into ligation and non-ligation groups.
• Blood samples were collected pre- and post-esophagectomy.
• T lymphocyte subsets (CD3+, CD3+CD4+, CD3+CD8+) were analyzed via flow cytometry.

Main Results:

• No significant pre-operative differences in lymphocyte subsets between groups.
• Post-operatively, the ligation group showed decreased CD3+ and CD3+CD4+ T lymphocyte percentages.
• The ligation group exhibited an increased CD3+CD8+ T lymphocyte percentage post-operatively.

Conclusions:

• Thoracic duct ligation during esophagectomy can reduce T lymphocyte and CD4+ T lymphocyte percentages.
• These immune changes are more pronounced after transection of the arch of the azygos vein.
• Selective ligation of the thoracic duct is advised during esophagectomy.