Nutritional and prognostic effects of thoracic duct obliteration during esophagectomy

Thoracic duct obliteration (TDO), either ligation or resection, is performed during esophagectomy to enhance oncological radicality or manage chylothorax. However, its nutritional and oncological effects are unclear. We retrospectively analyzed patients undergoing esophagectomy for esophageal cancer at our institution between January 2016 and May 2024. We assessed laboratory parameters and computed tomography-derived body composition indices from diagnosis to 9-12 months postoperatively (15-25 months for laboratory data). We also analyzed nutritional indices, overall survival (OS), and recurrence-free survival (RFS). A total of 82 patients underwent TDO, and 313 did not (non-TDO). After propensity score matching, we included 75 TDO and 150 non-TDO patients. The TDO group achieved a higher lymph node yield, without affecting chylothorax incidence, nutritional or body composition indices, OS, RFS, or recurrence patterns between the TDO and non-TDO groups. However, analysis of neoadjuvant therapy (NAT) subgroup found more subcutaneous fat loss 3-6 months postoperatively in TDO patients (-55.35% vs. -32.93%, P = 0.002). This difference was no longer evident at 9-12 months (-42.97% vs. -42.89%, P = 0.859). Among the NAT patients, thoracic duct resection was associated with better OS and RFS than non-resection (3-year OS: 77.15% vs. 57.25%, P = 0.038; 3-year RFS: 72.41% vs. 48.08%, P = 0.049). In conclusion, TDO during esophagectomy does not compromise long-term nutritional or oncological outcomes in patients with esophageal cancer. In the NAT subgroup, transient subcutaneous fat loss was evident during the early postoperative period but was no longer apparent after a year. Survival outcomes were better among NAT patients who received thoracic duct resection.