Curative Effects of Different Sequences of Vessel Interruption During the Completely Thoracoscopic Lobectomy on Early Stage Non-Small Cell Lung Cancer

Abstract

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.

Advantages and disadvantages of single incision VATS in major anatomical resection for lung cancer

“…However, no clinical outcome measures were reported. In contrast, two other studies reported by Rafaely and co-workers (11) and Li and co-workers (12) analysing the long-term results in comparative manner of artery-first or vein-first division of the vessels yielded no difference in recurrence or survival in patients who underwent resection for lung cancer.…”

Vein-first versus artery-first ligation procedure for lung cancer surgery: An updated review

“…On the other hand, the disadvantages of vein-rst lung resection should not be neglected. Li et al reported that vein-rst procedure was associated with more intraoperative blood loss as compared with artery-rst surgeries [13]. It might be di cult to separate the PV rst before the removal of calci ed lymph nodes around the PV.…”

“…[4,5,[10][11][12][13][14].Vein-rst ligation was performed on 869 patients, while the other 819 patients underwent arteryrst surgery. Among them, 4 studies indicated that the interruption sequence of the vessels did not signi cantly affect the survival; whereas the other 3 studies demonstrated an obvious survival bene t for the patients in vein-rst group.The RCT by Kozak et al randomized 385 NSCLC patients in the vein-rst (n = 170) and artery-rst group (n = 215) respectively[10], which demonstrated similar 5-year OS.…”

Technical aspects of video-assisted and robotic-assisted thoracoscopic segmentectomy

“…Somewhat more important seems to be the finding of Kurusu and colleagues, that more circulating tumor cells were seen in patients in whom the artery was ligated before the vein during lobectomy (19). So far, no clinical impact of the sequence of vessel ligation on tumor recurrence (20) or long-term survival was demonstrated (18). Since any additional manipulation of the lung during surgery could possibly result in an increase in tumor recurrence, a pragmatic sequence of vessel ligation should be chosen (20).…”

“…Regarding the access to the segmental hilum, the primary dissection of the artery in the fissure can help identifying the basic anatomy (17). For VATS lobectomies, Li et al showed that there was significantly less bleeding when the artery was ligated first (105 vs. 148 mL) (18). However, this difference did not have any clinical impact on short term patient outcomes.…”