Indications, techniques, and clinical outcomes of thoracic duct interventions in patients: a forgotten literature?
J Surg Res 2016;
204:213-27. [PMID:
27451889 DOI:
10.1016/j.jss.2016.04.050]
[Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 04/13/2016] [Accepted: 04/20/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND
The evolution of the "gut-lymph concept" has promoted thoracic duct (TD) lymph drainage as a possible treatment to reduce systemic inflammation and end-organ dysfunction in acute illness. The aim was to review the published experience of thoracic duct interventions (TDIs) aimed at improving clinical outcomes.
METHODS
A search of three databases (MEDLINE, EMBASE, and EMBASE CLASSIC) over the last 60 y. The indications for intervention, the technique, and clinical outcomes were reviewed.
RESULTS
There were a wide range of indications for TDI. These included reducing rejection after transplantation, treating inflammatory diseases, and reducing chronic failure of the liver, kidney, and heart. The techniques included TD cannulation and lymphovenuous fistula. The outcomes were variable and often equivocal, and this appears to reflect poor design quality. There is clinical equipoise regarding a therapeutic role of (TD lymph drainage in acute pancreatitis, and probably other acute diseases.
CONCLUSIONS
Until well-designed clinical trials are undertaken, the clinical benefits of TDIs will remain promising, but uncertain.
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