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Surgery is still the best treatment for early lung cancer currently, but approximately 40%-50% of patients will develop distant metastases after the operation. It was reported through pulmonary vein during an operation that remote dissemination may occur. 1) How to improve surgical methods and reduce the incidence of distant metastases and lower mortality is the direction of the continuous efforts of thoracic surgeons. Of note, whether different sequences of pulmonary artery and vein interruption during the operation have different effects on the metastatic dissemination of carcinomas remains controversial. Curative Effects of Different Sequences of Vessel Interruption During the Completely Thoracoscopic Lobectomy on Early Stage Non-Small Cell Lung CancerFengwei Li, MD, 1,2 Guanchao Jiang, MD, 1 Yingtai Chen, MD, 2 and Jun Wang, MD 1Objective: To study the correlation between prognosis and different sequences of pulmonary artery and vein interruption during completely thoracoscopic lobectomy for early stage non-small cell lung cancer. Methods: Retrospective analysis of 334 cases underwent completely thoracoscopic lobectomy, which were identified as stage I∼II non-small cell lung cancer by pathology. They were divided into three groups according to the order of vessel interruption: pulmonary vein first (Group V, n = 174), pulmonary artery first (Group A, n = 93), and artery-vein-artery group (Group M, n = 67). Their preoperative and operative conditions, and the postoperative survival, recurrence were compared. Results: Group A had less cases with history of smoking but more with history of pulmonary infection. The average bleeding amount during the operation in Group A is significantly less Group V, and Group M fell in between them. The duration of operation and postoperative complications were similar among the three groups. The types of tumor recurrence were also similar, which were mostly distant metastasis. There was no statistically significant difference in tumor-free survival and overall survival among the three groups. Conclusions: For the treatment of stage I∼II non-small cell lung cancer using completely thoracoscopic lobectomy, pulmonary artery interruption first can reduce the bleeding amount without affecting the operative difficulty and postoperative complications. The sequence of vessel interruption during lobectomy by thoracoscopic surgery would not affect tumor recurrence, metastasis and survival.

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