• Taro Oshikiri, Hodaka Numasaki, Junya Oguma, Yasushi Toh, Masayuki Watanabe, Manabu Muto, Yoshihiro Kakeji, and Yuichiro Doki.
• Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan.
• Ann. Surg. 2023 May 1; 277 (5): e1018e1025e1018-e1025.

ObjectiveTo clarify whether routine thoracic duct (TD) resection improves the prognosis of patients with esophageal cancer after radical esophagectomy.Summary Of Background DataAlthough TD resection can cause nutritional disadvantage and immune suppression, it has been performed for the resection of surrounding lymph nodes.MethodsWe analyzed 12,237 patients from the Comprehensive Registry of Esophageal Cancer in Japan who underwent esophagectomy between 2007 and 2012. TD resection and preservation groups were compared in terms of prognosis, perioperative outcomes, and initial recurrent patterns using strict propensity score matching. Particularly, the year of esophagectomy and history of primary cancer of other organs were added as covariates.ResultsAfter propensity score matching, 1638 c-Stage I-IV patients participated in each group. The 5 year overall survival and cause-specific survival rates were 57.5% and 65.6% in the TD-resected group and 55.2% and 63.4% in the TD-preserved group, respectively, without significant differences. The TD-resected group had significantly more retrieved mediastinal nodes (30 vs 21, P < 0.0001) and significantly fewer lymph node recurrence (376 vs 450, P = 0.0029) compared with the TD-preserved group. However, the total number of distant metastatic organs was significantly greater in TD-resected group than in the TD-preserved group (499 vs 421, P = 0.0024).ConclusionsTD resection did not improve survival in patients with esoph-ageal cancer. Despite having retrieved more lymph nodes, TD resection caused distant metastases in more organs compared to TD preservation. Hence, prophylactic TD resection should not be recommended in patients with esophageal cancer.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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