title: Indications, techniques, and clinical outcomes of thoracic duct interventions in patients: a forgotten literature?
abstract: The evolution of the "gut-lymph concept" has promoted thoracic duct (TD) lymph drainage as a possible treatment to reduce systemic inflammation and end-organ dysfunction in acute illness. The aim was to review the published experience of thoracic duct interventions (TDIs) aimed at improving clinical outcomes.
  
  
  
  A search of three databases (MEDLINE, EMBASE, and EMBASE CLASSIC) over the last 60 y. The indications for intervention, the technique, and clinical outcomes were reviewed.
  
  
  
  There were a wide range of indications for TDI. These included reducing rejection after transplantation, treating inflammatory diseases, and reducing chronic failure of the liver, kidney, and heart. The techniques included TD cannulation and lymphovenuous fistula. The outcomes were variable and often equivocal, and this appears to reflect poor design quality. There is clinical equipoise regarding a therapeutic role of (TD lymph drainage in acute pancreatitis, and probably other acute diseases.
  
  
  
  Until well-designed clinical trials are undertaken, the clinical benefits of TDIs will remain promising, but uncertain.
authors.affiliation: Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Applied Surgery and Metabolism Laboratory, School of Biological Science, Faculty of Science, University of Auckland, Auckland, New Zealand.
authors.forename: Hsiang-Wei
authors.initials: HW
authors.lastname: Wang
authors.affiliation: Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Alistair Brian James
authors.initials: AB
authors.lastname: Escott
authors.affiliation: Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Applied Surgery and Metabolism Laboratory, School of Biological Science, Faculty of Science, University of Auckland, Auckland, New Zealand.
authors.forename: Kian Luke
authors.initials: KL
authors.lastname: Phang
authors.affiliation: Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Maxim S
authors.initials: MS
authors.lastname: Petrov
authors.affiliation: Applied Surgery and Metabolism Laboratory, School of Biological Science, Faculty of Science, University of Auckland, Auckland, New Zealand.
authors.forename: Anthony Ronald John
authors.initials: AR
authors.lastname: Phillips
authors.affiliation: Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. Electronic address: j.windsor@auckland.ac.nz.
authors.forename: John Albert
authors.initials: JA
authors.lastname: Windsor
mesh_terms: D016638:Critical Illness; D004322:Drainage / Q000379:methods*; D006084:Graft Rejection / Q000601:surgery*; D006801:Humans; D007249:Inflammation / Q000601:surgery*; D009102:Multiple Organ Failure / Q000601:surgery*; D013897:Thoracic Duct / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cannulation; Clinical outcomes; Drainage; Immunodepletion; Intervention; Lymph; Thoracic duct