Prophylactic thoracic duct ligation is associated with poor prognosis and regional lymph node relapse in esophageal squamous cell carcinoma

2020 ◽  
Vol 122 (2) ◽  
pp. 336-343
Author(s):  
Jun‐Ying Chen ◽  
Qian‐Wen Liu ◽  
Shui‐Shen Zhang ◽  
Jin‐Bo Li ◽  
Hong Yang ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Thoracic Duct ◽  
Poor Prognosis ◽  
Regional Lymph Node ◽  
Thoracic Duct Ligation ◽  
Duct Ligation

scholarly journals Salvage treatment for lymph node recurrence after radical resection of esophageal squamous cell carcinoma

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jie Chen ◽  
Wenming Yin ◽  
Hui Yao ◽  
Wendong Gu
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Regional Lymph Node ◽  
Radical Resection ◽  
Salvage Treatment ◽  
Lymph Node Recurrence

Abstract Background Patients with regional lymph node recurrence after radical resection of esophageal cancer have poor therapeutic outcomes. Currently, there is no standard treatment for regional lymph node recurrence, and its prognostic risk factors are not well-understood. This study retrospectively analyzed 83 patients with postoperative regional lymph node recurrence after radical resection of esophageal squamous cell carcinoma. The aim was to evaluate the clinical efficacy and prognostic factors of salvage radiotherapy with or without chemotherapy in these patients. Methods The survival and prognostic factors of 83 patients with esophageal squamous cell carcinoma with regional lymph node recurrence after radical surgery were retrospectively analyzed. All patients underwent radiotherapy, of which 74 patients received volumetric modulated arc therapy (VMAT), 9 patients received three-dimensional conformal radiation therapy (3DCRT), administered using a conventional segmentation protocol with a dose distribution range of 50.4–66.2Gy (median dose of 60Gy). In total, 41 patients received radiotherapy alone, 42 received radiotherapy combined with chemotherapy, and the concurrent chemotherapy regimen was mainly composed of either platinum or fluorouracil monotherapy, except for 4 patients who were given 5-fluorouracil plus platinum (FP) or paclitaxel plus platinum (TP). Results The median follow-up time was 24 (range, 9–75) months. The overall survival (OS) rates at 1 year, 2 years, 3 years, and 5 years were 83.0, 57.1, 40.1, and 35.1%, respectively. The median overall survival (OS) time was 18 (range, 5–75) months. The 3-year survival rate was 47.5% in patients with radiation alone and 41.9% in patients receiving concurrent chemoradiotherapy(p = 0.570), while the response rate (CR + PR) in those two groups was 73.2 and 91.4%, respectively. By multivariate analysis of OS, age (worse in younger patients, p = 0.034) was found to be significantly associated with disease prognosis. The commonly toxicities were esophagitis, neutropenia and anemia. 18% patients experienced grade 3 toxicity and no treatment-related death occurred. Conclusions These results of this retrospective analysis suggest that radiotherapy with or without chemotherapy is an effective and feasible salvage treatment for lymph node recurrence after radical resection of esophageal squamous cell carcinoma.

scholarly journals Effect of Thoracic Duct Ligation During VATS Esophagectomy On T Cell Subset and DFS in Squamous Cell Carcinoma Patients With T1b-3N0M0 Stage

2021 ◽  
Author(s):  
Ruifeng Yang ◽  
Yan Zhang ◽  
Xiao-mei Li ◽  
Ya-chen Sun ◽  
Run-qi Zhang ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Thoracic Duct ◽  
Tumor Thrombus ◽  
Depth Of Invasion ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Significant Difference ◽  
Degree Of Differentiation

Abstract Objective: To study whether the ligation of thoracic duct during video-assisted thoracic surgery esophagectomy will cause damage to the immune system, thus affecting the disease-free survival(DFS) of patients with cT1b-3N0M0 stage. Methods: We studied the esophageal squamous cell carcinoma confirmed by endoscopic ultrasound biopsy and PET-CT. They were randomly divided into thoracic duct ligation group and non ligation group. In addition to thoracoscopic resection of esophageal cancer, thoracic duct ligation was also performed in the experimental group. The peripheral blood T lymphocyte subsets were detected by flow cytometry during perioperation. All patients were reexamined regularly after operation in order to find recurrence or metastasis early. The Chi-square test and t-test were employed for statistical analysis with statistical significance at p<0.05.The effect of thoracic duct ligation on DFS curves were calculated by the Kaplan–Meier method and compared by the log-rank test. A Cox regression model with stepwise selection was used for the multivariate analyses.Result: After early screening and late exclusion, a total of 67 patients entered the study and completed the follow-up. There was no significant difference in gender, age, tumor location, depth of invasion, degree of differentiation and presence of tumor thrombus between the ligation group (32 cases) and the non ligation group (35 cases). There was no significant difference in T lymphocyte subsets before and 3 weeks after operation, but there was significant difference on the 1st days after operation. Cox regression analysis showed that depth of invasion (P= 0.0020), degree of differentiation (P= 0.0262), presence of tumor thrombus (P = 0.0158) and thoracic duct ligation (P= 0.0036) were independent factors affecting DFS.Conclusion: Thoracic duct ligation can affect the short-term immune function after thoracoscopic esophagectomy in squamous cell carcinoma patients with pT1b-3N0M0 stage, and the thoracic duct ligation, depth of invasion, degree of differentiation and presence of tumor thrombus are independent factors affecting DFS. Trial registration: Chinese Clinical Trial Registry, ChiCTR-IOR-17010437 . Registered 15 January 2017, https://www.chictr.org.cn/edit.aspx?pid=17254&htm=4

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