Different dissecting orders of the pulmonary bronchus and vessels during right upper lobectomy are associated with surgical feasibility and postoperative recovery for lung cancer patients

Background: Right upper lobectomy(RUL) for lung cancer with di erent dissecting orders involves the most vari?able anatomical structures, but no studies have analyzed its e ects on postoperative recovery. This study compared the conventional surgical approach, VAB(dissecting pulmonary vessels first, followed by the bronchus), and the alter?native surgical approach, a BVA(dissecting the posterior ascending arterial branch first, followed by the bronchus and vessels) on improving surgical feasibility and postoperative recovery for lung cancer patients.Methods: According to the surgical approach, consecutive lung cancer patients undergoing RUL were grouped into a BVA and VAB cohorts. Their clinical, pathologic, and perioperative characteristics were collected to compare periop?erative outcomes.Results: Three hundred one patients were selected(109 in the a BVA cohort and 192 in the VAB cohort). The mean operation time was shorter in the a BVA cohort than in the VAB cohort(164 vs. 221 min, P < 0.001), and less blood loss occurred in the a BVA cohort(92 vs. 141 m L, P < 0.001). The rate of conversion to thoracotomy was lower in the a BVA cohort than in the VAB cohort(0% vs. 11.5%, P < 0.001). The mean duration of postoperative chest drainage was shorter in the a BVA cohort than in the VAB cohort(3.6 vs. 4.5 days, P rvival was n= 0.001). The rates of postoperative complica?tions were comparable(P = 0.629). The median overall suot arrived in both cohorts(P > 0.05). The median disease?free survival was comparable for all patients in the two cohorts(not arrived vs. 41.97 months) and for patients with disease recurrences(13.25 vs. 9.44 months)(both P > 0.05). The recurrence models in two cohorts were also comparable for patients with local recurrences(6.4% vs. 7.8%), distant metastases(10.1% vs. 8.3%), and both(1.8% vs. 1.6%)(all P > 0.05).Conclusions: Dissecting the right upper bronchus before turning over the lobe repeatedly and dissecting veins via the a BVA approach during RUL would promote surgical feasibility and achieve comparable postoperative recovery for lung cancer patients.

右上肺叶切除术中肺支气管和血管不同的解剖顺序与肺癌患者的手术可行性和术后恢复相关

背景与目的不同解剖顺序的肺癌右上肺叶切除术(right upper lobectomy,RUL)涉及十分多变的解剖结构,但仍没有研究分析其对术后恢复的影响。本研究比较了常规手术入路VAB(首先解剖肺血管,然后是支气管)和另一种手术入路aBVA(先解剖后升动脉,然后是支气管和血管),在肺癌患者手术可行性和术后恢复方面的差异。方法根据手术方法,将接受RUL的肺癌患者分为aBVA和VAB两组。并收集他们的临床信息、病理资料和围手术期特征,用以比较围手术期结局。结果 301例患者纳入研究(aBVA组109例和VAB组192例)。aBVA组的平均手术时间短于VAB组(164 min vs. 221 min,P <0.001),aBVA组的出血量比VAB组更少(92 mL vs. 141 mL,P <0.001)。aBVA组行开胸手术的比率低于VAB组(0%vs. 11.5%,P <0.001)。术后胸腔引流的平均持续时间aBVA组比VAB组短(3.6 d vs. 4.5 d,P=0.001)。两组的术后并发症发生率相似(P=0.629)。两组均未达到中位总生存期(P> 0.05)。比较了两组中所有患者的中位无病生存期(未达到vs. 41.97个月)(P> 0.05)和疾病复发患者的中位无病生存期(13.25个月vs. 9.44个月)(P>0.05)。在两组中对复发类型也进行了比较:局部复发率(6.4%vs. 7.8%)、远处转移率(10.1%vs. 8.3%)、局部复发合并远处转移率(1.8%vs. 1.6%)(均P> 0.05)。结论在RUL中采用aBVA方法,在反复翻转肺叶和解剖静脉之前解剖右上支气管,将可提高肺癌患者的手术可行性和促进术后恢复。