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Background: Compared to other hollow viscus organs, the oesophagus has a unique anatomy in which lymphatic channels are abundantly present in the mucosa and submucosa. It has been hypothesized that tumour cells can directly disseminate from these superficial layers into the thoracic duct without passing juxta-tumoral lymph nodes. We investigated whether tumour cells of an oesophageal carcinoma could be detected in the thoracic duct during operative manipulation., Methods: In patients with an adenocarcinoma of the oesophagus and/or gastro-oesophageal junction, undergoing a transthoracic resection with two-field lymphadenectomy, lymph was collected and cells were immunostained., Results: Tumour cells could be detected in the thoracic duct lymph of only 1 out of 19 patients during operative manipulation., Conclusion: Peroperative data from this study do not support the hypothesis that oesophageal carcinoma readily metastasizes directly into the thoracic duct., (Copyright 2001 S. Karger AG, Basel)

Background/aims: Bacterial translocation is postulated as a risk factor in the development of a systemic inflammatory response syndrome (SIRS). Research on this topic has focused on the detection of bacteria and endotoxin in blood or mesenteric lymph nodes (MLNs). We investigated whether bacterial translocation occurs beyond the MLNs into the thoracic duct in a setting of ischemia, partial resection and reperfusion of the porcine liver., Methods: A porcine model of severe, extra-intestinal tissue injury, consisting of prolonged hepatic ischemia and reperfusion, in combination with hemihepatectomy, was used (experimental group, n = 5 pigs). To prevent venous congestion of the gut during ischemia, a temporary portal-caval shunt was created. In 5 animals (sham group) a sham portal-caval shunt was constructed while liver ischemia, partial resection and reperfusion were not induced. Thoracic duct lymph, portal blood and systemic blood were collected, and analyzed for the presence of bacteria and endotoxin., Results: In the experimental group, the incidence of bacterial translocation to the thoracic duct was significantly higher during early reperfusion compared to the sham group (5/5 animals versus 1/5 animals, p < 0.05)., Conclusion: This study demonstrates bacterial translocation into the thoracic duct. Translocation at this level leads to direct discharge of bacteria and endotoxin into the systemic circulation and therefore, may potentially enhance the development of SIRS.