Small Modifications in Technique May Yield Large Rewards After Lung Cancer Surgery
Mené en Chine sur 86 patients atteints d'un cancer du poumon non à petites cellules, cet essai multicentrique évalue, du point de vue de l'évolution du nombre de cellules tumorales circulantes exprimant le récepteur aux folates après le traitement chirurgical et du point de vue des taux de survie à 5 ans, l'efficacité d'une ligature première des veines durant l'intervention chirurgicale par rapport à une ligature première des artères
The explanation for the development of recurrent disease, especially distant metastases, in patients with completely resected pathologic early-stage lung cancer has eluded physicians for decades. Since 2015, spread of tumor through air spaces, a previously unrecognized phenomenon, has been accepted as a mechanism of tumor recurrence after lung resection. Surgeons are increasingly familiar with molecular and genetic markers that characterize aggressive lung tumor behavior, which may suggest the need for systemic adjuvant therapy, even in patients with completely resected early-stage cancers.The study by Wei et al adds to our understanding of how metastases develop in patients with early-stage lung cancer and how this may be associated with survival. The authors found that all patients undergoing resection had circulating tumor cells prior to their operations. They demonstrated that ligating the lobar venous outflow as the first step in a lobectomy was associated with reduced number of circulating tumor cells in the bloodstream compared with initial arterial ligation, presumably by reducing the amount of manipulation of the tumor and by early occlusion of tumor cells’ means of egress into the systemic circulation.