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

Abstract

BACKGROUND:

The optimal sequence of pulmonary vessel interruption during lung cancer resection remains controversial. This review aimed to elucidate the association of vein-first versus artery-first ligation and survival of the patients.

METHODS:

We searched PubMed, Web of Science, Scopus, Embase, Cochrane Library and Google Scholar from their inception to September 2021 for published articles that compared vein-first (the pulmonary vein was interrupted first) and artery-first procedure (the pulmonary artery was ligated first) during lung cancer surgery.

RESULTS:

Finally, a total of 13 full articles were obtained. First, 7 studies with survival information were included for meta-analyses. As compared with the artery-first ligation, vein-first approach did not decrease the risk of local recurrence (risk ratio [RR] 0.92 in favour of vein-first; 95% confidence interval [CI] 0.61-1.39, p = 0.68) or distant metastasis (RR 0.92; 95% CI 0.30-2.85, p = 0.89); but it was associated with better disease-free survival (RR 0.52; 95% CI 0.37-0.73, p < 0.01) as well as 5-year overall survival (RR 0.60; 95% CI 0.41-0.86, p < 0.01). In addition, the operative time, intraoperative blood loss, total complications, and length of postoperative stay were mainly comparable between the two groups. Second, 7 studies provided the data of tumor cells indicated by different biomarkers and detection methods; and 3 of these reports showed that vein-first ligation decreased the extent of intraoperative tumor dissemination. However, a quantitative meta-analysis was not possible due to the significant heterogeneity.

CONCLUSION:

Vein-first ligation in lung cancer surgery may be associated with improved survival of the patients, which might be ascribed to potentially lower risk of tumor cell dissemination. Well-designed, large-scale trials are warranted to clarify these occasional findings.

• Authors: Tian Zhao, Chu Zhang, Chen Zhao, Wen-Bin Wu, Miao Zhang
• Journal: Journal of cardiothoracic surgery (J Cardiothorac Surg) Vol. 16 Issue 1 Pg. 272 (Sep 26 2021) ISSN: 1749-8090 [Electronic] England
• PMID: 34565438 (Publication Type: Journal Article, Review)
• Copyright: © 2021. The Author(s).

Topics

• Carcinoma, Non-Small-Cell Lung (surgery)
• Humans
• Ligation
• Lung Neoplasms (surgery)
• Neoplasm Recurrence, Local
• Pneumonectomy
• Pulmonary Artery (surgery)