Does prophylactic ligation of the thoracic duct reduce chylothorax rates in patients undergoing oesophagectomy? A systematic review and meta-analysis

A systematic review of English and non-English articles using OVID MEDLINE (1980–2014) was performed to evaluate the potential valueof 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 incidenceof chylothorax in patients who underwent prophylactic ligation [ligation group (LG)] with that in those who had conservative treatmentwere selected [preservation group (PG)]; all the articles presenting original data and supplying sufficient information on thechylothorax rate after oesophagectomy were included. Independent extraction of articles was performed by two authors using predefineddata fields, including study quality indicators. The PRISMA guidelines were carefully adhered to. A total of 5254 subjects were included inthe 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 ourmeta-analysis and taking into account-specific caveats, prophylactic ligation of the thoracic duct could be considered as an effective preventativemeasure to reduce the incidence of postoperative chylothorax.