The following is the summary of “Early ligation of the pulmonary vein can reduce the dissemination of shed tumor cells during thoracoscopic lobectomy” published in the December 2022 issue of Thoracic and cardiovascular surgery by Duan, et al.

It has been shown that the hematogenous dissemination of circulating tumor cells (CTC) is strongly impacted by the order in which vessels are ligated during lobectomy. When comparing artery-first ligation with vein-first ligation, it is clear that the latter significantly lowers CTC diffusion and yields better survival rates. In this study, researchers looked into whether the early versus late PV ligation technique for determining pulmonary vein (PV) ligation timing is related to CTC spread. In all, 44 patients were enrolled, all of whom had had lobectomy via standard 2-port video-assisted thoracoscopic surgery. Subjects were categorized into two groups, early ligation (n=18) and late ligation (n=26), based on when PV ligation was performed during the operation.

Both before and after lobe resection, blood was drawn from the PVs. Validation was performed using FlowSight and fluorescent in situ hybridization after CTCs were identified using telomerase reverse transcriptase-based CTC detection. In comparison to the median preoperative PV CTC (Pre-PVCTC) count of 1 (IQR, 0-3; P<.001), the median postoperative PV CTC (Post-PVCTC) count was 9 (IQR, 6-18). Analysis of clinicopathologic correlations revealed that TNM stage (P=.002) and lymph node metastasis (P=.002) were significantly connected with pre-PVCTC count, while post-PVCTC count was strongly correlated with tumor density (P=.043) and vessel/lymphatic invasion (P<.030).

Intriguingly, although there was no statistical difference in the median Pre-PVCTC count, there was a significant difference (P=.004) in the median Post-PVCTC count: 16 (IQR, 9.5-36.75) in the early ligation group and 8 (IQR, 4.75-12.25) in the late ligation group. Offering a novel surgical paradigm for the principal sequence of pulmonary vascular management, researchers present the first evidence that early PV ligation can prevent the dissemination of PVCTCs into circulation.

Source: sciencedirect.com/science/article/pii/S0022522322004792