Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Thorac Cardiovasc Surg. 2022 Dec;164(6):1623-1635.e2. doi: 10.1016/j.jtcvs.2022.03.038. Epub 2022 Apr 20.
The sequence of vessel ligation in lobectomy can significantly affect the hematogenous spread of circulating tumor cells (CTCs). Vein-first ligation substantially reduces CTC dissemination and achieves favorable survival compared with artery-first ligation. In this study, we further explored whether the timing of pulmonary vein (PV) ligation determined according to the early and late PV ligation technique is associated with CTC dissemination.
A total of 44 patients who underwent uniform 2-port video-assisted thoracoscopic surgery lobectomy were enrolled; the subjects were divided into the early ligation group (n = 18) and late ligation group (n = 26) according to whether PV ligation was prioritized during surgery. PV blood was obtained before PV ligation and after lobe resection. CTCs were detected using telomerase reverse transcriptase-based CTC detection and validated using FlowSight and fluorescence in situ hybridization.
The median postoperative PV CTC (Post-PVCTC) count was 9 (interquartile range [IQR], 6-18), which was higher than the median preoperative PV CTC (Pre-PVCTC) count of 1 (IQR, 0-3; P < .001). Clinicopathologic correlation analysis showed that the Pre-PVCTC count correlated positively with TNM stage (P = .002) and lymph node metastasis (P = .002) and that the Post-PVCTC count correlated positively with tumor density (P = .043) and vessel/lymphatic invasion (P < .030). Interestingly, although no statistical difference in the median Pre-PVCTC count was observed, the median Post-PVCTC count in the early ligation group was 16 (IQR, 9.5-36.75), whereas that in the late ligation group it was 8 (IQR, 4.75-12.25), showing a significant difference (P = .004).
We provide the first evidence to show that early PV ligation can prevent PVCTCs from spreading into the circulation, offering an innovative surgical concept for the principle sequence of pulmonary vessel management.
在肺叶切除术中，血管结扎的顺序会显著影响循环肿瘤细胞（CTC）的血行播散。与动脉优先结扎相比，静脉优先结扎可显著减少 CTC 的播散，并获得更好的生存结果。在这项研究中，我们进一步探讨了根据早期和晚期肺静脉（PV）结扎技术确定的 PV 结扎时间是否与 CTC 播散有关。
共纳入 44 例行 2 孔电视辅助胸腔镜手术肺叶切除术的患者，根据手术中是否优先结扎 PV 将患者分为早期结扎组（n=18）和晚期结扎组（n=26）。在结扎 PV 前和肺叶切除后采集 PV 血样。采用端粒酶逆转录酶法 CTC 检测法检测 CTC，并采用 FlowSight 和荧光原位杂交法进行验证。
中位术后 PVCTC（Post-PVCTC）计数为 9（四分位距 [IQR]，618），高于术前 PVCTC（Pre-PVCTC）计数 1（IQR，03；P<0.001）。临床病理相关性分析显示，Pre-PVCTC 计数与 TNM 分期（P=0.002）和淋巴结转移（P=0.002）呈正相关，而 Post-PVCTC 计数与肿瘤密度（P=0.043）和脉管/淋巴管侵犯（P<0.030）呈正相关。有趣的是，尽管 Pre-PVCTC 计数的中位数无统计学差异，但早期结扎组的 Post-PVCTC 计数中位数为 16（IQR，9.536.75），而晚期结扎组为 8（IQR，4.7512.25），差异有统计学意义（P=0.004）。
本研究首次提供证据表明，早期 PV 结扎可防止 PVCTC 扩散到循环中，为肺血管处理的原则顺序提供了一个创新的手术概念。
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