Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 1;280(5):780-787.
doi: 10.1097/SLA.0000000000006490. Epub 2024 Aug 13.

The Near-Infrared Visualization and Preemptive Ligation of the Thoracic Duct Effectively Reduce the Chyle Leak Incidence After Minimally Invasive Esophagectomy

Francesco Puccetti  1   2 , Lorenzo Cinelli  1 , Lavinia A Barbieri  1 , Davide Socci  1 , Di Serio Clelia  3 , Francesco De Cobelli  2   4 , Ugo Elmore  1   2 , Riccardo Rosati  1   2 ; OSR CCeR Collaborative Group†∥
Collaborators, Affiliations

The Near-Infrared Visualization and Preemptive Ligation of the Thoracic Duct Effectively Reduce the Chyle Leak Incidence After Minimally Invasive Esophagectomy

Francesco Puccetti et al. Ann Surg. .

Abstract

Objective: The aim of the present study is to assess the effectiveness of indocyanine-green (ICG)-guided lymphography (ICG-Lg) in reducing the incidence of chyle leak (CL) after esophagectomy.

Background: Chylothorax may severely impact esophageal cancer surgery, and the pre-emptive ligation of the thoracic duct (TD) is the most widespread control of this complication. Intraoperative ICG-Lg has been recently embedded in minimally invasive esophagectomy to facilitate TD detection and pre-emptive ligation.

Methods: This retrospective analysis included consecutive patients who underwent minimally invasive Ivor Lewis esophagectomy for cancer at a tertiary referral center between January 2018 and August 2023. Patients were routinely submitted to extended lymphadenectomy with TD ligation and removal. All patients treated after January 2021 underwent ICG-Lg for TD identification and ligation (ICG group) and compared with the previous series (no-ICG group). The primary outcome was the incidence of postoperative CL, while univariate and backward stepwise multivariate logistic regression models were performed to identify associated factors.

Results: After including 320 patients, 151 (ICG group) were submitted to ICG-Lg before the pre-emptive TD ligation. Both groups presented similar characteristics, except for neoadjuvant therapy ( P <0.001) and preoperative comorbidities ( P =0.045). Intraoperative ICG-Lg significantly reduced the incidence of postoperative CL (11.8% vs 4.6%, P =0.026) and was significantly associated with shorter median length of hospital stay (13 vs 9 d, P =0.006). However, CL after ICG-Lg was more likely to require repairing reoperation ( P =0.050).

Conclusions: Intraoperative ICG-Lg demonstrated significantly lower rates of CL after total minimally invasive esophagectomy and, therefore, it should be routinely embedded in the standardized surgical technique of high-volume centers for esophageal cancer.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

References

    1. Power R, Smyth P, Donlon NE, et al. Management of chyle leaks following esophageal resection: a systematic review. Dis Esophagus. 2021;34:doab012.
    1. Lagarde SM, Omloo JM, de Jong K, et al. Incidence and management of chyle leakage after esophagectomy. Ann Thorac Surg. 2005;80:449–454.
    1. Machleder HI, Paulus H. Clinical and immunological alterations observed in patients undergoing long-term thoracic duct drainage. Surgery. 1978;84:157–165.
    1. Hagens ERC, Feenstra ML, Eshuis WJ, et al. Conditional survival after neoadjuvant chemoradiotherapy and surgery for oesophageal cancer. Br J Surg. 2020;107:1053–1061.
    1. Defize IL, Schurink B, Weijs TJ, et al. The anatomy of the thoracic duct at the level of the diaphragm: a cadaver study. Ann Anat. 2018;217:47–53.

MeSH terms

Substances