Revisiting Thoracic Duct Resection in Esophageal Squamous Cell Carcinoma: A Propensity-Matched Analysis and...

Area of Science:

• Surgical Oncology
• Gastrointestinal Oncology
• Immunology

Background:

• Esophageal squamous cell carcinoma (ESCC) is aggressive with poor prognosis.
• Thoracic duct resection (TDR) is sometimes performed during esophagectomy to reduce recurrence.
• The impact of TDR on clinical and immunological outcomes is debated.

Purpose of the Study:

• To evaluate the prognostic significance of intraoperative thoracic duct resection (TDR) in ESCC patients.
• To determine if TDR affects overall survival (OS) and recurrence-free survival (RFS).

Main Methods:

• Retrospective analysis of 722 ESCC patients undergoing McKeown esophagectomy.
• Classification into TDR and TD-preserved groups.
• Propensity score matching (PSM) followed by Kaplan-Meier and Cox regression analyses for OS and RFS comparison.

Main Results:

• After PSM, no significant differences in median OS or survival rates between TDR and TD-preserved groups.
• Recurrence-free survival (RFS) was also similar between groups (p=0.31).
• TDR was associated with a higher recurrence risk in node-negative (pN0) patients (HR, 2.09; p=0.013).

Conclusions:

• Intraoperative TDR does not improve long-term survival in ESCC patients.
• TDR may increase recurrence risk in early-stage, node-negative patients.
• Routine TDR should be avoided; indications should be individualized.