To the Editor There is still no agreement on whether vein-first ligation should be recommended for non–small cell lung cancer (NSCLC) surgery, and thoracic surgeons choose based on their own preferences and surgical habits. Some advocate vein-first ligation because it might reduce tumor cell dissemination, while others advocate artery-first ligation because it might decrease unnecessary blood loss.1,2 Previous literatures have drawn controversial conclusions in comparison of vein-first ligation and artery-first ligation and the only randomized clinical trial, to our knowledge, found no correlation between sequence of vessel ligation and survival of patients with NSCLC.3 Wei et al4 retrospectively compared the survival of patients with NSCLC receiving vein-first ligation and these receiving artery-first ligation via propensity score analysis and found that vein-first ligation procedure was significantly correlated with better survival compared with artery-first ligation, which was applausively supported by further randomized analysis comparing folate receptor–positive circulating tumor cells in peripheral blood between vein-first ligation procedure and artery-first ligation procedure. Therefore, with sufficient reasons, the authors recommended ligating vein first for NSCLC surgery.
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Deng H. Vein-First Ligation Procedure for Lung Cancer Surgery. JAMA Surg. Published online September 11, 2019. doi:10.1001/jamasurg.2019.3483
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