Does Vein First Hilar Division Improve Survival After Lung Cancer Resection?

There continues to be controversy on whether to ligate the pulmonary arterial branches or the pulmonary veins first when performing a lobectomy. Proponents of taking the pulmonary arterial branches first argue that this approach decreases pulmonary venous congestion and blood loss. However, the majority of cancer related deaths are due to metastatic disease, and ligating the pulmonary veins first prior to any significant manipulation of the lung may help prevent the release of circulating tumor cells. This chapter provides an overview of the available evidence on the sequence of pulmonary vessel ligation and whether ligating the pulmonary vein first leads to improved survival after lung cancer resection.