Published in:
01-08-2018 | Original Article
Effects of vessel interruption sequence during thoracoscopic lobectomy for non-small cell lung cancer
Authors:
Ryota Sumitomo, Takamasa Fukui, Satoshi Marumo, Yosuke Otake, Cheng-long Huang
Published in:
General Thoracic and Cardiovascular Surgery
|
Issue 8/2018
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Abstract
Objective
This study aimed to determine if the vessel interruption sequence during thoracoscopic lobectomy affects disease recurrence.
Methods
We retrospectively analyzed 187 consecutive patients who underwent video-assisted thoracoscopic surgery lobectomy with curative intent for non-small cell lung cancer between January 2007 and December 2013. Their clinicopathological, operative, and postoperative data were compared. Patients with minimally invasive adenocarcinoma were excluded.
Results
A total of 104 patients underwent total venous interruption before interruption of any artery branch (V-first), while 83 patients underwent some artery interruption first (non-V-first). Clinicopathological characteristic distributions were similar between both groups except for the resected lobe. Seven of 104 patients in the V-first group and 15 of 83 patients in the non-V-first group experienced disease recurrences. Among the 187 patients who underwent thoracoscopic lobectomy, overall survival tended to be longer in the V-first group than in the non-V-first group (P = 0.080). Furthermore, disease-free survival was significantly longer in the V-first group than in the non-V-first group (P = 0.019), particularly in stage I patients (P = 0.047). Multivariate analysis showed that vessel interruption sequence was a significant prognostic factor for poor disease-free survival, after adjusting for pathological stage and histology (hazard ratio 2.127; 95% confidence interval 1.009–4.481). There was no significant difference in intraoperative blood loss between both groups.
Conclusions
Interrupting the pulmonary vein first may be associated with improved disease-free survival in patients undergoing thoracoscopic lobectomy for non-small cell lung cancer.