Different dissecting orders of the pulmonary bronchus and vessels during right upper lobectomy are associated with surgical feasibility and postoperative recovery for lung cancer patients

Abstract

BackgroundRight upper lobectomy (RUL) for lung cancer with different dissecting orders involves the most variable anatomical structures, but no studies have analyzed its effects on postoperative recovery. This study compared the conventional surgical approach, VAB (dissecting pulmonary vessels first, followed by the bronchus), and the alternative surgical approach, aBVA (dissecting the posterior ascending arterial branch first, followed by the bronchus and vessels) on improving surgical feasibility and postoperative recovery for lung cancer patients.MethodsAccording to the surgical approach, consecutive lung cancer patients undergoing RUL were grouped into aBVA and VAB cohorts. Their clinical, pathologic, and perioperative characteristics were collected to compare perioperative outcomes.ResultsThree hundred one patients were selected (109 in the aBVA cohort and 192 in the VAB cohort). The mean operation time was shorter in the aBVA cohort than in the VAB cohort (164 vs. 221 min, P < 0.001), and less blood loss occurred in the aBVA cohort (92 vs. 141 mL, P < 0.001). The rate of conversion to thoracotomy was lower in the aBVA cohort than in the VAB cohort (0% vs. 11.5%, P < 0.001). The mean duration of postoperative chest drainage was shorter in the aBVA cohort than in the VAB cohort (3.6 vs. 4.5 days, P = 0.001). The rates of postoperative complications were comparable (P = 0.629). The median overall survival was not arrived in both cohorts (P > 0.05). The median disease-free survival was comparable for all patients in the two cohorts (not arrived vs. 41.97 months) and for patients with disease recurrences (13.25 vs. 9.44 months) (both P > 0.05). The recurrence models in two cohorts were also comparable for patients with local recurrences (6.4% vs. 7.8%), distant metastases (10.1% vs. 8.3%), and both (1.8% vs. 1.6%) (all P > 0.05).ConclusionsDissecting the right upper bronchus before turning over the lobe repeatedly and dissecting veins via the aBVA approach during RUL would promote surgical feasibility and achieve comparable postoperative recovery for lung cancer patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s40880-017-0220-9) contains supplementary material, which is available to authorized users.

Comparison of the effects of sevoflurane and propofol anesthesia on pulmonary function, MMP‑9 and postoperative cognition in patients receiving lung cancer resection

“…Especially, lung cancer resection impairs the cognitive function of patients to a certain extent. Under the influence of surgical resection of lung tissue, lung cancer resection can reduce the ratio of ventilation volume to blood flow to a certain extent, resulting in hypoxemia and impairment of cognitive function of patients (24). In this study, there was no significant difference in MMSE score between sevoflurane and propofol group 1 day before surgery (P>0.05).…”

aBVA Procedure by Uniportal Video-Assisted Thoracoscopic Surgery for Right Upper Peripheral Lung Cancer: A Randomized Trial

“…Traditionally, it has been suggested that the pulmonary vein be cut first to avoid dissemination of tumor cells, which could consequently lead to blood micrometastasis and treatment failure (17)(18)(19)(20)(21). However, other studies concluded that the sequence of ligation of pulmonary vessels did not seem to influence oncological outcomes or survival (22)(23)(24). Despite the controversy, we still performed wedge resections first for the sake of clarity in the present study.…”

Multi‐center experience in an optimized right upper lobectomy surgical procedure in China

“…The other two recently introduced novel methods involve simultaneous manipulation of the right superior pulmonary vein along with the superior arterial trunk to decrease the number of surgical steps and use of endovascular staplers. 12 , 13 Lin et al 12 have reported their experience in first dividing oblique fissures to expose, isolate, and transect the upper bronchus; then dividing horizontal fissures; and finally performing simultaneous transection of the right superior veins with arteries. Furthermore, Zhai et al 13 have described a similar method in which the ascending A2 artery is disconnected as the first priority (Asc.…”

“… 12 , 13 Lin et al 12 have reported their experience in first dividing oblique fissures to expose, isolate, and transect the upper bronchus; then dividing horizontal fissures; and finally performing simultaneous transection of the right superior veins with arteries. Furthermore, Zhai et al 13 have described a similar method in which the ascending A2 artery is disconnected as the first priority (Asc. A2‐B‐Fissure‐AV).…”