{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T16:13:40Z","timestamp":1785687220036,"version":"3.56.0"},"reference-count":45,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T00:00:00Z","timestamp":1741824000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: The effect of thoracic duct (TD) management\u2014resection, ligation, or preservation\u2014during esophagectomy for cancer remains controversial. This systematic review and meta-analysis aimed to assess the impact of TD management strategies on oncological outcomes and surgical morbidity. Methods: A systematic review and meta-analysis were performed following PRISMA reporting guidelines. Searches of OVID, Embase, and Web of Science identified studies comparing thoracic duct resection or TD ligation with TD preservation in esophagectomy for cancer. Outcomes included 5-year overall survival (OS), postoperative morbidity, postoperative chyle leakage, lymph node yield, and length of stay. Random-effects meta-analyses using the Hartung-Knapp-Sidik-Jonkman variance correction were conducted. Results: A total of 17 studies involving 4200 patients were included. TD resection was associated with a significantly higher lymph node yield (mean difference [MD]: 4, 95% CI: 0 to 8, p = 0.043), but also increased risk of chyle leakage (odds ratio [OR]: 2.41, 95% CI: 1.04\u20135.61, p = 0.044). There was no significant improvement in 5-year OS with TD resection compared to TD preservation (hazard ratio [HR]: 0.94, 95% CI: 0.76\u20131.17, p = 0.48). TD ligation showed no significant differences in 5-year OS (HR: 1.15, 95% CI: 0.81\u20131.63, p = 0.33) or morbidity compared to TD preservation. Certainty of evidence was low across outcomes. Conclusions: TD resection increases lymph node yield but is associated with higher rates of chyle leakage, without a significantly improved overall survival. TD ligation does not significantly affect oncological or surgical outcomes compared to TD preservation. A higher grade of evidence is needed to determine the definitive oncological and surgical impact of TD management strategies.<\/jats:p>","DOI":"10.3390\/cancers17060967","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T10:16:45Z","timestamp":1741861005000},"page":"967","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Resection vs. Ligation vs. Preservation of the Thoracic Duct During Esophagectomy for Cancer: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"17","author":[{"given":"David J.","family":"Nijssen","sequence":"first","affiliation":[{"name":"Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Cancer Center Amsterdam, Cancer Treatment and Quality of Life, 1066 CX Amsterdam, The Netherlands"},{"name":"Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6954-6883","authenticated-orcid":false,"given":"Dillen C.","family":"van der Aa","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Cancer Center Amsterdam, Cancer Treatment and Quality of Life, 1066 CX Amsterdam, The Netherlands"},{"name":"Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0511-6323","authenticated-orcid":false,"given":"Mahsoem","family":"Ali","sequence":"additional","affiliation":[{"name":"Cancer Center Amsterdam, Cancer Treatment and Quality of Life, 1066 CX Amsterdam, The Netherlands"},{"name":"Department of Surgery, Amsterdam UMC location Vrije Universiteit, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert","family":"Kazemier","sequence":"additional","affiliation":[{"name":"Cancer Center Amsterdam, Cancer Treatment and Quality of Life, 1066 CX Amsterdam, The Netherlands"},{"name":"Department of Surgery, Amsterdam UMC location Vrije Universiteit, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1452-1769","authenticated-orcid":false,"given":"Faridi S.","family":"Jamaludin","sequence":"additional","affiliation":[{"name":"Medical Library AMC, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0344-6695","authenticated-orcid":false,"given":"Wietse J.","family":"Eshuis","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Cancer Center Amsterdam, Cancer Treatment and Quality of Life, 1066 CX Amsterdam, The Netherlands"},{"name":"Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8689-3134","authenticated-orcid":false,"given":"Mark I.","family":"van Berge Henegouwen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Cancer Center Amsterdam, Cancer Treatment and Quality of Life, 1066 CX Amsterdam, The Netherlands"},{"name":"Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9655-7601","authenticated-orcid":false,"given":"Suzanne S.","family":"Gisbertz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Cancer Center Amsterdam, Cancer Treatment and Quality of Life, 1066 CX Amsterdam, The Netherlands"},{"name":"Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1991","DOI":"10.1016\/S0140-6736(24)02226-8","article-title":"Oesophageal cancer","volume":"404","author":"Yang","year":"2024","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.athoracsur.2021.02.041","article-title":"The Presence of Metastatic Thoracic Duct Lymph Nodes in Western Esophageal Cancer Patients: A Multinational Observational Study","volume":"113","author":"Defize","year":"2022","journal-title":"Ann. Thorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1002\/ca.22337","article-title":"Review of thoracic duct anatomical variations and clinical implications","volume":"27","author":"Phang","year":"2014","journal-title":"Clin. Anat."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Plutecki, D., Bonczar, M., Wilk, J., Necka, S., Joniec, M., Elsaftawy, A., Matuszyk, A., Walocha, J., Koziej, M., and Ostrowski, P. (2024). The Anatomy of the Thoracic Duct and Cisterna Chyli: A Meta-Analysis with Surgical Implications. J. Clin. Med., 13.","DOI":"10.3390\/jcm13154285"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e192","DOI":"10.1097\/AS9.0000000000000192","article-title":"Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers: An International Consensus Statement","volume":"3","author":"Kamarajah","year":"2022","journal-title":"Ann. Surg. Open"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1097\/SLA.0000000000005116","article-title":"Outcomes of Esophagogastric Cancer Surgery During Eight Years of Surgical Auditing by the Dutch Upper Gastrointestinal Cancer Audit (DUCA)","volume":"274","author":"Voeten","year":"2021","journal-title":"Ann. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/j.athoracsur.2005.02.076","article-title":"Incidence and management of chyle leakage after esophagectomy","volume":"80","author":"Lagarde","year":"2005","journal-title":"Ann. Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.athoracsur.2017.01.117","article-title":"Outcome of a Step-Up Treatment Strategy for Chyle Leakage After Esophagectomy","volume":"104","author":"Weijs","year":"2017","journal-title":"Ann. Thorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1016\/j.ejso.2016.11.013","article-title":"Hospital costs of complications after esophagectomy for cancer","volume":"43","author":"Goense","year":"2017","journal-title":"Eur. J. Surg. Oncol. EJSO"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"doac047","DOI":"10.1093\/dote\/doac047","article-title":"Clinical implications of chyle leakage following esophagectomy","volume":"36","author":"Schafrat","year":"2022","journal-title":"Dis. Esophagus"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1007\/s10388-014-0433-9","article-title":"Should lymph nodes along the thoracic duct be dissected routinely in radical esophagectomy?","volume":"11","author":"Udagawa","year":"2014","journal-title":"Esophagus"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"107271","DOI":"10.1016\/j.ejso.2023.107271","article-title":"Impact of thoracic duct resection during radical esophagectomy on oncological and survival outcomes: Systematic review","volume":"50","author":"Farrow","year":"2024","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4053","DOI":"10.1245\/s10434-019-07627-x","article-title":"Thoracic Duct Resection During Esophagectomy Does Not Contribute to Improved Prognosis in Esophageal Squamous Cell Carcinoma: A Propensity Score Matched-Cohort Study","volume":"26","author":"Oshikiri","year":"2019","journal-title":"Ann. Surg. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1002\/ags3.12594","article-title":"Intraoperative visualization of morphological patterns of the thoracic duct by subcutaneous inguinal injection of indocyanine green in esophagectomy for esophageal cancer","volume":"6","author":"Tokumaru","year":"2022","journal-title":"Ann. Gastroenterol. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"5319","DOI":"10.1007\/s00464-021-08912-1","article-title":"Near infra-red fluorescence identification of the thoracic duct to prevent chyle leaks during oesophagectomy","volume":"36","author":"Barnes","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s13643-021-01626-4","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"10","author":"Page","year":"2021","journal-title":"Syst. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan\u2014A web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Hozo, S.P., Djulbegovic, B., and Hozo, I. (2005). Estimating the mean and variance from the median, range, and the size of a sample. BMC Med. Res. Methodol., 5.","DOI":"10.1186\/1471-2288-5-13"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/1745-6215-8-16","article-title":"Practical methods for incorporating summary time-to-event data into meta-analysis","volume":"8","author":"Tierney","year":"2007","journal-title":"Trials"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1245\/s10434-019-07304-z","article-title":"Effect of Resection of the Thoracic Duct and Surrounding Lymph Nodes on Short- and Long-Term and Nutritional Outcomes After Esophagectomy for Esophageal Cancer","volume":"26","author":"Yoshida","year":"2019","journal-title":"Ann. Surg. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e3839","DOI":"10.1097\/MD.0000000000003839","article-title":"Clinical outcome of transthoracic esophagectomy with thoracic duct resection: Number of dissected lymph node and distribution of lymph node metastasis around the thoracic duct","volume":"95","author":"Matsuda","year":"2016","journal-title":"Medicine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1756","DOI":"10.1016\/j.ejso.2014.05.002","article-title":"Prophylactic thoracic duct ligation has unfavorable impact on overall survival in patients with resectable oesophageal cancer","volume":"40","author":"Hou","year":"2014","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1002\/jso.25948","article-title":"Prophylactic thoracic duct ligation is associated with poor prognosis and regional lymph node relapse in esophageal squamous cell carcinoma","volume":"122","author":"Chen","year":"2020","journal-title":"J. Surg. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2691","DOI":"10.1245\/s10434-022-12891-5","article-title":"Is Thoracic Duct Resection Necessary for Esophageal Squamous Cell Carcinoma Patients Treated with Neoadjuvant Chemoradiotherapy? A Propensity-Matched Analysis Based on the Comprehensive Registry of Esophageal Cancer in Japan","volume":"30","author":"Oshikiri","year":"2023","journal-title":"Ann. Surg. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"4402","DOI":"10.1245\/s10434-021-09962-4","article-title":"Thoracic Duct Resection Has a Favorable Impact on Prognosis by Preventing Hematogenous Spread of Esophageal Cancer Cells: A Multi-institutional Analysis of 2269 Patients","volume":"28","author":"Tanaka","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"8414","DOI":"10.1245\/s10434-021-10222-8","article-title":"Nutritional Outcomes of Thoracic Duct Resection for Radical Esophagectomy by Assessing Body Composition Changes in One Year: A Single-Center Retrospective Study","volume":"28","author":"Fujisawa","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4909","DOI":"10.1245\/s10434-022-11496-2","article-title":"Skeletonizing En Bloc Esophagectomy Revisited: Oncologic Outcome in Association with the Presence of Thoracic Duct Lymph Nodes","volume":"29","author":"Kim","year":"2022","journal-title":"Ann. Surg. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"11","DOI":"10.21037\/jgo-22-985","article-title":"Short-term clinical effects of robot-assisted esophagectomy with thoracic duct resection","volume":"14","author":"Li","year":"2023","journal-title":"J. Gastrointest. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e1018","DOI":"10.1097\/SLA.0000000000005340","article-title":"Prognosis of Patients with Esophageal Carcinoma After Routine Thoracic Duct Resection: A Propensity-matched Analysis of 12,237 Patients Based on the Comprehensive Registry of Esophageal Cancer in Japan","volume":"277","author":"Oshikiri","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1002\/bjs.11487","article-title":"Minimally invasive oesophagectomy with extended lymph node dissection and thoracic duct resection for early-stage oesophageal squamous cell carcinoma","volume":"107","author":"Matsuda","year":"2020","journal-title":"Br. J. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"5023","DOI":"10.1007\/s00464-019-07297-6","article-title":"Short- and long-term outcomes of prophylactic thoracic duct ligation during thoracoscopic-laparoscopic McKeown esophagectomy for cancer: A propensity score matching analysis","volume":"34","author":"Bao","year":"2020","journal-title":"Surg. Endosc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1007\/s00464-011-2032-3","article-title":"Prevention of postoperative chylothorax with thoracic duct ligation during video-assisted thoracoscopic esophagectomy for cancer","volume":"26","author":"Guo","year":"2012","journal-title":"Surg. Endosc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"5532","DOI":"10.21037\/jtd-20-1341","article-title":"The influence of thoracic duct ligation on long-term survival of patients with esophageal cancer: A propensity score-matched analysis","volume":"12","author":"Fei","year":"2020","journal-title":"J. Thorac. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1770","DOI":"10.1016\/j.athoracsur.2011.02.070","article-title":"Prevention of chylothorax complicating extensive esophageal resection by mass ligation of thoracic duct: A random control study","volume":"91","author":"Lai","year":"2011","journal-title":"Ann. Thorac. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"288","DOI":"10.29271\/jcpsp.2022.03.288","article-title":"Survival Analysis of Patients with Thoracic Duct Ligation during Thoracoscopic Esophagectomy","volume":"32","author":"Yang","year":"2022","journal-title":"J. Coll. Physicians Surg. Pak."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"S713","DOI":"10.21037\/jtd.2017.07.42","article-title":"The extent of lymphadenectomy in esophageal resection for cancer should be standardized","volume":"9","author":"Hagens","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"5683","DOI":"10.1245\/s10434-024-15475-7","article-title":"Extent and Boundaries of Lymph Node Stations During Minimally Invasive Esophagectomy: A Survey Among Dutch Esophageal Surgeons","volume":"31","author":"Ketel","year":"2024","journal-title":"Ann. Surg. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s10388-024-01054-y","article-title":"Japanese Classification of Esophageal Cancer, 12th Edition: Part I","volume":"21","author":"Mine","year":"2024","journal-title":"Esophagus"},{"key":"ref_41","first-page":"ED000142","article-title":"Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions","volume":"2019","author":"Cumpston","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Aiolfi, A., Bona, D., Cal\u00ec, M., Manara, M., Rausa, E., Bonitta, G., Elshafei, M., Markar, S.R., and Bonavina, L. (2024). Does Thoracic Duct Ligation at the Time of Esophagectomy Impact Long-Term Survival? An Individual Patient Data Meta-Analysis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13102849"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"doad065","DOI":"10.1093\/dote\/doad065","article-title":"History and evidence for state of the art of lymphadenectomy in esophageal cancer surgery","volume":"37","author":"Schuring","year":"2024","journal-title":"Dis. Esophagus"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1097\/01.shk.0000238068.84826.52","article-title":"Lymphatic thoracic duct ligation modulates the serum levels of IL-1\u03b2 and IL-10 after intestinal ischemia\/reperfusion in rats with the involvement of tumor necrosis factor \u03b1 and nitric oxide","volume":"27","author":"Cavriani","year":"2007","journal-title":"Shock"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Sch\u00fcnemann, H.J., Higgins, J.P., Vist, G.E., Glasziou, P., Akl, E.A., Skoetz, N., Guyatt, G.H., Cochrane GRADEing Methods Group (Formerly Applicability and Recommendations Methods Group), and The Cochrane Statistical Methods Group (2019). Completing \u2018Summary of findings\u2019 tables and grading the certainty of the evidence. Cochrane Handbook for Systematic Reviews of Interventions, Wiley.","DOI":"10.1002\/9781119536604.ch14"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/6\/967\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:52:47Z","timestamp":1760028767000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/6\/967"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,13]]},"references-count":45,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["cancers17060967"],"URL":"https:\/\/doi.org\/10.3390\/cancers17060967","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,13]]}}}