Is posterıor ascendıng artery dıssectıon necessary In rıght upper lobectomy vıa video-assısted thoracoscopıc surgery?
Abstract
ABSTRACT Objective: During lobectomy with Video-Assisted Thoracoscopic Surgery (VATS); vascular dissection is one of the stages that should be performed carefully and meticulously. Especially bleeding during dissection of pulmonary artery branches may cause life-threatening complications. In this study, different techniques developed by two surgeons depending on whether the posterior ascending artery (PAA) was dissected during right upper lobectomy operation; operation, drainage, discharge time and complication rates were investigated. Methods: This study included 180 patients who underwent right upper lobectomy with VATS for non-small cell lung cancer (NSCLC) over a 10-year period. Patients were divided into two groups: Group A (n = 90, patients without PAA dissection) and Group B (n = 90, patients with PAA dissection). Demographic characteristics, tumor histology and stage, operation, drainage and discharge times of the patients were compared. Results: The mean age of all patients was 63.5 (38.0-85.0), tumor size was 2.5 (0.5-8.0) cm, and surgery duration was 235.0 (45.0-420.0) minutes. In terms of operative techniques of two different surgeons, operative time was statistically significantly shorter in patients without PAA dissection (213.9±64.5 minutes) compared to patients with PAA dissection (269.3±61.2 minutes) (p <0.001). In addition, patients in stages 2B and 3A were significantly higher in the group without PAA dissection (p <0.015). Adenocarcinoma cases were significantly higher in patients without PAA dissection (n = 80, 88.9% vs. n = 66, 77.3%; p = 0.019), while squamous carcinomas were significantly higher in the PAA dissection group (n = 22, 24.4% vs. n = 8, 8.9%; p = 0.019). When the complication rates were compared, it was seen that they were lower in the PAA dissection group than in the PAA dissection group and were statistically significant (p = 0.011). When the drainage times were compared, no significant difference was observed between the two groups. Conclusion: This study is the first study to date to compare different surgical approaches to the posterior segment artery in upper lobectomy with VATS. PAA division without dissection with a parenchymal stapler in right upper lobectomies may be a recommended surgical method because it shortens the operation time, reduces the risk of bleeding during dissection, and reduces complication rates.
Keywords
References
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Details
Primary Language
English
Subjects
Clinical Oncology
Journal Section
Research Article
Publication Date
July 30, 2026
Submission Date
September 9, 2025
Acceptance Date
April 27, 2026
Published in Issue
Year 2026 Volume: 40 Number: 3