Impact of prophylactic thoracic duct obliteration on chylothorax rates in patients undergoing oesophagectomy: A systematic review and meta-analysis

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Background Chylothorax after oesophagectomy occurs in up to 8.9% of cases, resulting in significant morbidity, such as, malnutrition, respiratory distress, and immunosuppression. Prophylactic thoracic duct obliteration through ligation (TDL) or resection (TDR) is proposed to reduce the incidence of chylothorax. However, the impact of these procedures on chylothorax incidence and long-term survival outcomes remain unclear. Methods The study protocol was registered at PROSPERO (registration number: CRD42025643054). A systematic review and meta-analysis of 18 studies (12,651 patients) was conducted. The primary outcome was the incidence of chylothorax; secondary outcomes included reoperation rates, postoperative mortality, 5-year survival, and length of hospital stay. Results TDR increased the incidence of chylothorax (RR 2.63; 95%CI, 1.07-6.44, p =0.04). No significant differences were found in reoperation rates, mortality, or length of hospital stay. There was no impact on 5-year overall survival (HR 0.96; 95%CI 0.90-1.02, I 2 =33%; p =0.17). Conclusions Prophylactic thoracic duct obliteration, particularly TDR, may increase chylothorax incidence but does not affect long-term survival or other postoperative outcomes.