Sampling Thoracic Duct Lymph After Esophagectomy: A Pilot Study Investigating the "Gut-Lymph" Concept.

Show simple item record Escott, Alistair Brian James Hong, Jiwon Connor, Brigid Nancy Phang, Kian Liun Holden, Andrew Hugh Phillips, Anthony Ronald John Windsor, John Albert
dc.coverage.spatial United States 2022-04-21T04:35:35Z 2022-04-21T04:35:35Z 2021-9-28
dc.identifier.issn 1539-6851
dc.description.abstract <b><i>Introduction:</i></b> Gut-lymph in animal models of acute disease is altered by intestinal ischemia and contributes to the development of systemic inflammation and organ dysfunction. Investigating gut-lymph in humans is hampered difficulty in accessing the thoracic duct (TD) for lymph sampling. The aims of this study were to develop and pilot a technique of intraoperative TD cannulation with delayed embolization to serially measure TD lymph pressure, flow, and composition (including markers of intestinal injury) during the early postoperative period and in response to enteral feeding and vasopressor treatment. <b><i>Methods:</i></b> A Seldinger technique was used for percutaneous TD cannulation during an Ivor Lewis esophagogastrectomy. Lymph flow rate and pressure were measured. TD lymph and plasma were sampled at 12 hourly intervals for up to 120 hours after surgery and before TD embolization. Biochemistry, lipids, cytokines, and markers of intestinal injury were measured before and after enteral feeding commenced at 36 hours. <b><i>Results:</i></b> Intraoperative TD cannulation was technically feasible in three of four patients. Delayed TD embolization was only successful in one of three patients, with two patients requiring a re-thoracotomy to treat chylothorax. Profound changes in TD composition, but not flow rate, occurred over time and in response to enteral feeding and vasopressors. TD lymph compared with plasma had significantly higher lipase (1.4-17 × ), interleukin-6 (8-108 × ), tumor necrosis factor-α (2.7-17 × ), d-lactate (0.3-23 × ), endotoxin (0.1-41 × ), and intestinal fatty acid binding protein (1.1-853 × ). <b><i>Conclusions:</i></b> Although TD cannulation and lymph sampling were successful, TD embolization failed in two of three patients. The composition of sampled TD lymph changed dramatically in response to enteral feeding, indicating intestinal ischemia that could be exacerbated by nonselective vasopressors. The higher concentration of proinflammatory cytokines and gut injury markers in TD lymph, compared with plasma, lends support to the gut-lymph concept.
dc.format.medium Print-Electronic
dc.language eng
dc.publisher Mary Ann Liebert Inc
dc.relation.ispartofseries Lymphatic research and biology
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher.
dc.subject enteral feeding
dc.subject esophagectomy
dc.subject gut-lymph
dc.subject systemic inflammation
dc.subject thoracic duct
dc.subject vasopressors
dc.subject 1107 Immunology
dc.title Sampling Thoracic Duct Lymph After Esophagectomy: A Pilot Study Investigating the "Gut-Lymph" Concept.
dc.type Journal Article
dc.identifier.doi 10.1089/lrb.2019.0037 2022-03-06T19:07:17Z
dc.rights.holder Copyright: The author en
pubs.publication-status Published
dc.rights.accessrights en
pubs.subtype Journal Article
pubs.elements-id 867981
dc.identifier.eissn 1557-8585 2021-9-28

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