Lessons learned from routine thoracic duct visualization using high-fat ice cream during esophagectomy: insights from...

Area of Science:

• Surgical Oncology
• Thoracic Surgery
• Gastroenterology

Background:

• Preventing thoracic duct (TD) injury during esophagectomy is crucial to avoid chylothorax.
• Existing methods for TD identification often require specialized equipment or large volumes of substances.
• A need exists for a simple, accessible, and effective method for intraoperative TD visualization.

Purpose of the Study:

• To standardize and evaluate a simple fat-loading protocol for reliable thoracic duct (TD) identification during esophagectomy.
• To assess the safety, efficacy, and impact of TD preservation facilitated by this protocol.
• To explore the oncologic implications of selective TD preservation in esophagectomy patients.

Main Methods:

• A protocol using a small dose of high-fat ice cream administered three hours before anesthesia induction was standardized.
• Thoracoscopic magnification was used in conjunction with the fat-loading protocol for TD visualization.
• Data were collected over a decade, focusing on TD visualization, chyle leaks, and oncologic outcomes.

Main Results:

• The fat-loading protocol achieved successful TD visualization in all cases without specialized imaging.
• No anesthesia-related adverse events were reported, and the protocol was well-tolerated.
• Preservation of a visualized TD was associated with fewer clinically relevant chyle leaks and comparable oncologic outcomes.

Conclusions:

• A simple, accessible fat-loading protocol reliably identifies the thoracic duct (TD) during esophagectomy, enabling strategic preservation.
• This approach enhances surgical safety, reduces chylothorax, and optimizes perioperative outcomes without compromising oncologic adequacy.
• Safe intraoperative TD management relies on reliable visualization and selective preservation rather than routine resection.