title: Does prophylactic ligation of the thoracic duct reduce chylothorax rates in patients undergoing oesophagectomy? A systematic review and meta-analysis.
abstract: A systematic review of English and non-English articles using OVID MEDLINE (1980-2014) was performed to evaluate the potential value of prophylactic ligation of the thoracic duct in preventing chylous leakage after oesophagectomy for cancer. Search terms included [Oesophagectomy OR esophagectomy] AND [chylothorax] AND [thoracic duct ligation]. Only those papers that directly compared the incidence of chylothorax in patients who underwent prophylactic ligation [ligation group (LG)] with that in those who had conservative treatment were selected [preservation group (PG)]; all the articles presenting original data and supplying sufficient information on the chylothorax rate after oesophagectomy were included. Independent extraction of articles was performed by two authors using predefined data fields, including study quality indicators. The PRISMA guidelines were carefully adhered to. A total of 5254 subjects were included in the 7 clinical studies examined into the current meta-analysis. Of these, 2179 patients underwent prophylactic ligature of the thoracic duct (LG group) and 3075 had preservation of the thoracic duct (PG group). A significant difference in terms of chylothorax rate [odd ratios (ORs) 0.47 in favour of LG, 95% confidence interval (CI) 0.27-0.80] was noted between the LG group and the PG group. According to our meta-analysis and taking into account-specific caveats, prophylactic ligation of the thoracic duct could be considered as an effective preventative measure to reduce the incidence of postoperative chylothorax.
authors.affiliation: Section of Thoracic Surgery, Department of Vascular Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Pierfilippo
authors.initials: P
authors.lastname: Crucitti
authors.affiliation: Section of Thoracic Surgery, Department of Vascular Surgery, Campus Bio-Medico University of Rome, Rome, Italy g.mangiameli@unicampus.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mangiameli
authors.affiliation: Department of Public Health, Hygiene and Statistics, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Tommasangelo
authors.initials: T
authors.lastname: Petitti
authors.affiliation: Section of Thoracic Surgery, Department of Vascular Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Adalgisa
authors.initials: A
authors.lastname: Condoluci
authors.affiliation: Section of Thoracic Surgery, Department of Vascular Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Rocco
authors.affiliation: Section of Thoracic Surgery, Department of Vascular Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Ida Francesca
authors.initials: IF
authors.lastname: Gallo
authors.affiliation: Section of Thoracic Surgery, Department of Vascular Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Longo
authors.affiliation: Department of Thoracic Surgery and Oncology, Division of Thoracic Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione Pascale, Napoli, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Rocco
mesh_terms: D002916:Chylothorax / Q000517:prevention & control*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008026:Ligation / Q000379:methods; D013897:Thoracic Duct / Q000601:surgery*
keywords: Chylothorax; Oesophagectomy OR esophagectomy; Thoracic duct ligation