In Reply We appreciate Deng for his interest in our study,1 and we would like to give our response to him. In our study, vein-first procedure did reduce the spread of tumor cells to the circulation in patients with stage III disease; however, a significant survival benefit was not observed in these patients. The metastasis of extrapulmonary lymph node prior to surgery might be an explanation for this result. The small sample size of patients with stage III disease in our study might be another reason. Nevertheless, surgeons should still consider how to reduce the dissemination of tumor cells to the greatest extent during surgery, which is a basic principle of surgical oncology. Therefore, vein-first procedure is also necessary to be recommended in patients with stage III disease. Further studies with large number of patients are warranted to clarify this.
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Wei S, Liu L. Vein-First Ligation Procedure for Lung Cancer Surgery. JAMA Surg. Published online September 11, 2019. doi:10.1001/jamasurg.2019.3495
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