Vein-first vs. artery-first robotic lobectomy outcomes in non-small cell lung cancer

Background: Data remains limited as to whether the order of pulmonary vessel division during performance of a lobectomy for non-small cell lung cancer (NSCLC) affects survival outcomes. Some authors have suggested that ligation of the pulmonary veins should be conducted first in order to minimize the spread of tumor cells secondary to manipulation of the lung. This study examines whether there is a difference in outcomes between patients who undergo robotic lobectomies for NSCLC using a vein-first (V-first) vs. artery-first (A-first) technique.Methods: A retrospective review of electronic medical record data was performed for patients who underwent robotic lobectomies from January 2013 to May 2019. Patients were separated into two groups based on the sequence in which the pulmonary vessels were divided: V-first or A-first. Baseline characteristics and postoperative events were recorded and compared between groups using Chi-squared and Student's t-tests. Kaplan-Meier survival curves for overall and recurrence-free survival were constructed and compared with log-rank tests.Results: A total of 374 patients were identified: 94 V-first and 280 A-first patients. There was no significant difference between the V-first and A-first groups with regards to postoperative complications, length of stay, recurrence-free survival, or overall survival.Conclusions: Our study suggests that choosing a V-first vs. A-first technique for a robotic lobectomy does not significantly impact overall survival or cancer recurrence for patients with NSCLC. Further studies are needed to evaluate whether the order of pulmonary vessel resection affects outcomes for patients with NSCLC.