Impact of Thoracic Duct Ligation on Postoperative Weight Reduction in Obese Patients Receiving Minimally Invasive Lung Surgery: A Clinical Investigation

Background:

Obesity (BMI≥28 kg/m²) is a global health crisis with limited effective interventions. Emerging evidence suggests that TDL-a routine step in esophagectomy-may reduce body weight and improve lipid profiles, but its therapeutic potential for metabolic modulation remains unexplored.

Objectives:

Primary: Assess safety and feasibility of TDL during video-assisted thoracoscopic surgery (VATS) for stage IA1-IB lung cancer with concurrent obesity (BMI≥30 kg/m²).

Secondary: Evaluate changes in body weight (%), lipid metabolism (LDL/HDL), inflammatory markers (CRP, IL-6), and fat-soluble vitamin levels.

Methods:

Single-center prospective cohort with longitudinal monitoring. Eligible patients will undergo VATS + TDL, with metabolic parameters measured preoperatively and at postoperative day 1/5, months 1/3/6/12.

Exploratory Endpoints:

• Weight loss trajectory (% total body weight)
• Mechanisms of metabolic reprogramming (e.g., gut hormone shifts)
• Procedure-related morbidity (lymphatic leakage, vitamin deficiency)

Significance:

First study to evaluate TDL as a potential metabolic therapy in non-esophageal surgery, providing preliminary data for future randomized trials.

Inclusion criteria

• Age & Gender: Individuals aged 18-75 years, regardless of gender.
• Clinical Profile:Diagnosed with early-stage lung cancer (stage IA1-IB) and obesity (BMI ≥28 kg/m²).
• Scheduled to undergo video-assisted thoracoscopic surgery (VATS) for right-sided lung cancer resection at our institution between October 2024 and October 2026.
• Surgical Eligibility: Approved for surgery following multidisciplinary team (MDT) assessment.
• Treatment Plan: No requirement for adjuvant therapy post-lung resection.
• Preoperative Evaluation:Completed standard preoperative workup, including:
• Chest CT、Brain CT/MRI、Abdominal ultrasound OR PET-CT to rule out distant metastasis.
• Informed Consent: Willing and able to comply with study requirements, with written informed consent provided.

Exclusion criteria

• Concurrent Thoracic Infections: Patients with active intrathoracic infectious diseases (e.g., inflammatory conditions, tuberculosis).
• Refusal of Novel Technique: Patients unwilling to undergo intraoperative thoracic duct ligation.
• Clinically Unstable Comorbidities: Severe, unstable cardiovascular, renal, or respiratory disorders.
• Prior Bariatric Surgery: History of weight-loss surgery (e.g., gastric bypass, sleeve gastrectomy).
• Recent Trial Participation: Enrollment in other clinical trials within 30 days prior to screening.
• Investigator Discretion: Other conditions deemed by the investigator to contraindicate participation.