Article Abstract

Association between different sequences of vessel ligation during video-assisted thoracoscopic lobectomy and survival in patients with non-small cell lung cancer

Authors: Huang-He He, Jia-Xi He, Zhe-Xue Hao, Wei Wang, Jian-Xing He

Abstract

Background: The aim of this retrospective study was to assess the influence of the sequence of pulmonary vessel ligation during video-assisted thoracoscopic lobectomy on long-term survival in patients with non-small cell lung cancer (NSCLC).
Methods: This retrospective study included 60 patients treated surgically with lobectomy and standard lymphadenectomy between 2012 and 2013. Patients had primary ligation of the pulmonary vein or veins (PV group, 33 patients) or of the pulmonary artery or arteries (PA group, 27 patients). Patients were excluded if they had undergone pulmonary wedge resection before lobectomy. Subgroup and sensitivity analyses were also used to investigate the effect of clinical characteristics of interest on survival.
Results: Median follow-up was 54.5 months. Baseline characteristics of the two groups were statistically comparable regarding gender, histology, type of resection, T stage, and overall stage (all P>0.05). Overall, 5-year survival reached 66.67% in the PV group and 44.44% in the PA group (P=0.084). There were no differences between two groups regarding overall survival (OS) (P=0.063, HR: 2.093; 95% CI: 0.960–4.564), disease-free survival (DFS) (P=0.180, HR: 1.539; 95% CI: 0.820–2.889), or cancer-specific deaths (P=0.227, 14/33 vs. 17/27). Subgroup analyses showed no significant difference of OS (P=0.374, HR: 1.541; 95%CI: 0.594–3.997) or DFS (PLog-rank=0.746) for isolated adenocarcinoma, but significant differences in OS (PLog-rank=0.036; HR: 3.992; 95% CI: 0.987–16.139) and DFS (P=0.044, HR: 3.011; 95% CI: 1.031–8.795) between the two groups of patients in whom squamous cell carcinomas. Sensitivity analysis showed that the differences were not statistically significant between the two groups regarding OS (P=0.140, HR: 1.944; 95%CI: 0.804–4.700) and DFS (P=0.190, HR: 1.605; 95% CI: 0.791–3.255) for patients with a tumour diameter of greater than 3 cm.
Conclusions: In summary, the sequence of pulmonary vessel ligation during video-assisted thoracoscopic lobectomy for NSCLC has no different effects on long-term survival, but for patients with squamous cell carcinoma, venous ligation should be preferred first since it may bring survival advantage after surgery.

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