Comparison Of Different Surgical Thoracic Duct Management On Prevention Of Postoperative Chylothorax For Esophagectomy:A Meta-analysis

Objective: To compare the clinical efficacy of different surgical thoracic duct management on prevention of postoperative chylothorax and its impact on the outcome of the patients.Methods: We searched the electronic bibliographic databases,including PubMed,Cochrane Library(Issue4,2016),Web of science,CBM,CNKI,VIP and Wanfang databases to assemble the randomized controlled trials(RCTs),cohort studies and case control studies related to the comparison of different surgical thoracic duct management during esophagectomy on prevention of postoperative chylothorax from inception to May 2016.Data were extracted and evaluated by two reviewers independently with a designed extraction form.The RevMan 5.2 software was used for meta-analysis on included studies.Results: Twenty-three trials were included,involving four randomized controlled trials(RCTs),four cohort studies and fifteen case-control studies.The results of Meta-analysis indicated :(1)Prophylactic thoracic duct ligation group has lower incidence of postoperative chylothorax compared with non thoracic duct ligation group.(RCT : OR=0.20,95%CI 0.09 to 0.47,P=0.0002;Co/CC:OR=0.20,95%CI 0.14 to 0.28,P<0.00001);(2)There were no significant differences between the two groups in the respect of mortality,morbidity and the 2-year,3-year,5-year survival rates(all P values>0.05);(3)Prophylactic thoracic duct ligation could reduce the reoperation rate of chylothorax complicating esophageal cancer patients(RCT : OR=0.13,95%CI 0.03 to 0.59,P=0.008;Co/CC:OR=0.18,95%CI 0.11 to 0.32),P<0.00001),but increase the cure rate of expectant treatment on them(OR=0.14,95%CI 0.04 to 0.54,P=0.004);(4)En bloc thoracic duct ligation group has a lower incidence of postoperative chylothorax compared with single thoracic duct ligation group(OR=3.67,95%CI 1.43 to 9.43,P=0.007).Conclusion: Prophylactic thoracic duct ligation during esophagectomy could effectively reduce the incidence of postoperative chylothorax and is good for reducing the reoperation rate of chylothorax complicating esophageal cancer patients.En bloc thoracic duct ligation has a better efficacy on prevention of postoperative chylothorax compared with single thoracic duct ligation.