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 circulation tumor cells (CTCs) dissemination and survival of the patients.
Methods
We searched PubMed, Web of Science, Scopus, Embase, Cochrane Library and Google Scholar from their inception to October 2020 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 included. First, 7 of these studies with survival data were included for meta-analysis. As compared with artery-first ligation, vein-first approach did not decrease local recurrence (risk ratio [RR] 0.96 in favour of vein-first ligation; 95% confidence interval [CI] 0.77–1.19, p = 0.68) or distant metastasis (RR 0.93; 95% CI 0.34–2.54, p = 0.89), but it was associated with better 5-year overall survival of the patients (RR 0.72; 95% CI 0.52–0.99, p = 0.04). Second, 7 studies provided the data of tumor cells using different biomarkers and detection methods; thus, a quantitative meta-analysis was not possible. Among them, 3 studies showed that vein-first decreased the extent of tumor dissemination.
Conclusion
Vein-first ligation in lung cancer surgery is associated with improved survival of the patients and potentially decreased surgery-related tumor dissemination. Further high-quality trials are warranted.
Vein-first versus artery-first ligation procedure for lung cancer surgery: An updated review