{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T11:10:05Z","timestamp":1780485005160,"version":"3.54.1"},"reference-count":70,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T00:00:00Z","timestamp":1715472000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Thoracic duct ligation (TDL) during esophagectomy has been proposed to reduce the risk of postoperative chylothorax. Because of its role in immunoregulation, some authors argued that it had an unfavorable TDL effect on survival. The aim of this study was to analyze the effect of TDL on overall survival (OS). Methods: PubMed, MEDLINE, Scopus, and Web of Science were searched through December 2023. The primary outcome was 5-year OS. The restricted mean survival time difference (RMSTD), hazard ratios (HRs), and 95% confidence intervals (CI) were used as pooled effect size measures. The GRADE methodology was used to summarize the certainty of the evidence. Results: Five studies (3291 patients) were included. TDL was reported in 54% patients. The patients\u2019 age ranged from 49 to 69, 76% were males, and BMI ranged from 18 to 26. At the 5-year follow-up, the combined effect from the multivariate meta-analysis is -3.5 months (95% CI \u22126.1, \u22120.8) indicating that patients undergoing TDL lived 3.5 months less compared to those without TDL. TDL was associated with a significantly higher hazard for mortality at 12 months (HR 1.54, 95% CI 1.38\u20131.73), 24 months (HR 1.21, 95% CI 1.12\u20131.35), and 28 months (HR 1.14, 95% CI 1.02\u20131.28). TDL and noTDL seem comparable in terms of the postoperative risk for chylothorax (RR = 0.66; p = 0.35). Conclusions: In this study, concurrent TDL was associated with reduced 5-year OS after esophagectomy. This may suggest the need of a rigorous follow-up within the first two years of follow-up.<\/jats:p>","DOI":"10.3390\/jcm13102849","type":"journal-article","created":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T09:28:25Z","timestamp":1715592505000},"page":"2849","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Does Thoracic Duct Ligation at the Time of Esophagectomy Impact Long-Term Survival? An Individual Patient Data Meta-Analysis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7764-6075","authenticated-orcid":false,"given":"Alberto","family":"Aiolfi","sequence":"first","affiliation":[{"name":"IRCCS Ospedale Galeazzi\u2014Sant\u2019Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4501-1187","authenticated-orcid":false,"given":"Davide","family":"Bona","sequence":"additional","affiliation":[{"name":"IRCCS Ospedale Galeazzi\u2014Sant\u2019Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6665-494X","authenticated-orcid":false,"given":"Matteo","family":"Cal\u00ec","sequence":"additional","affiliation":[{"name":"IRCCS Ospedale Galeazzi\u2014Sant\u2019Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4924-1919","authenticated-orcid":false,"given":"Michele","family":"Manara","sequence":"additional","affiliation":[{"name":"IRCCS Ospedale Galeazzi\u2014Sant\u2019Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6780-1783","authenticated-orcid":false,"given":"Emanuele","family":"Rausa","sequence":"additional","affiliation":[{"name":"IRCCS Ospedale Galeazzi\u2014Sant\u2019Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Bonitta","sequence":"additional","affiliation":[{"name":"IRCCS Ospedale Galeazzi\u2014Sant\u2019Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4419-9018","authenticated-orcid":false,"given":"Moustafa","family":"Elshafei","sequence":"additional","affiliation":[{"name":"Department of Bariatric and Metabolic Medicine, Clinic Northwest, 60488 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheraz R.","family":"Markar","sequence":"additional","affiliation":[{"name":"Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX1 2JD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4880-1670","authenticated-orcid":false,"given":"Luigi","family":"Bonavina","sequence":"additional","affiliation":[{"name":"IRCCS Policlinico San Donato, Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milan, 20097 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1158\/2326-6066.CIR-14-0115","article-title":"Immunomodulatory roles of lymphatic vessels in cancer progression","volume":"2","author":"Swartz","year":"2014","journal-title":"Cancer Immunol. 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