The impact of the sequence of pulmonary vessel ligation during anatomic resection for lung cancer on long-term survival – a prospective randomized trial

Kozak, Andrey; Alchimowicz, Jacek; Safranow, Krzysztof; Wójcik, Janusz; Kochanowski, L.; Kubisa, Bartosz; Pieróg, Jarosław; Grodzki, Tomasz

doi:10.2478/v10039-012-0061-3

Cited by 22 publications

(30 citation statements)

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“…For example, Kozak and co-workers divided patients into two groups: group A underwent ligation of the PA branch first (n=215) and group V underwent ligation of PV first (n=170). Although long-term survival was not influenced by the sequence of vessel ligation, hematogenous metastasis occurred with a higher incidence in group A than group V (20.5% vs. 14.7%, P=0.18) (25). In the present cohort of 30 patients, high ΔpvCTC group consisted of only patients with ligated PA first.…”

Section: Discussionmentioning

confidence: 47%

“…Indeed, the efficacy of ligating PV first to avoid tumor spillage during surgery for NSCLC was reported in several literatures (21,22). Even though several studies regarding the sequence of vessel ligation were conducted in NSCLC, significant correlation with clinical outcome remained unproven (22)(23)(24)(25)(26)(27). For example, Kozak and co-workers divided patients into two groups: group A underwent ligation of the PA branch first (n=215) and group V underwent ligation of PV first (n=170).…”

Section: Discussionmentioning

confidence: 99%

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Positive correlation between postoperative tumor recurrence and changes in circulating tumor cell counts in pulmonary venous blood (pvCTC) during surgical manipulation in non-small cell lung cancer

et al. 2018

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Positive correlation between postoperative tumor recurrence and changes in circulating tumor cell counts in pulmonary venous blood (pvCTC) during surgical manipulation in non-small cell lung cancer

et al. 2018

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“…The study compared the artery cut first group (215 cases) with the vein cut first group (170 cases) and found that there's no statistical difference in recurrence and survival between the two groups. 9) However, these studies all focused on thoracotomy lobectomy. Kurusu pointed out that the traction of pulmonary tissue increased the risk of recurrence and metastases.…”

Section: Discussionmentioning

confidence: 99%

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

Jiang

Chen

et al. 2015

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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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“…Therefore, interrupting the pulmonary veins before the lobe is repeatedly turned over and compressed would mitigate potential distant metastases. However, previous publications revealed controversial conclusions [19, 22, 28]. Refaely et al [22] revealed that the sequence of vessel dissection did not interfere and was not a risk factor for tumor recurrence (odds ratio = 1.29, 95% confidence interval 0.73–2.29, P = 0.40) based on the data of 279 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Refaely et al [22] revealed that the sequence of vessel dissection did not interfere and was not a risk factor for tumor recurrence (odds ratio = 1.29, 95% confidence interval 0.73–2.29, P = 0.40) based on the data of 279 patients. Another randomized trial conducted by Kozak et al [28] concluded that the 5-year survival rates of patients with the veins or arteries interrupted first were comparable. However, Sienel et al [19] determined that 18% (11/62) of patients were confirmed to have detectable tumor cells in the pulmonary veins.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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The impact of the sequence of pulmonary vessel ligation during anatomic resection for lung cancer on long-term survival – a prospective randomized trial

Cited by 22 publications

References 13 publications

Positive correlation between postoperative tumor recurrence and changes in circulating tumor cell counts in pulmonary venous blood (pvCTC) during surgical manipulation in non-small cell lung cancer

Positive correlation between postoperative tumor recurrence and changes in circulating tumor cell counts in pulmonary venous blood (pvCTC) during surgical manipulation in non-small cell lung cancer

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

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

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