The sequence of vessel interruption during lobectomy: does it affect the amount of blood retained in the lobe?

In a previous study, we have shown that the sequence of vessel interruption (SVI) during lobectomy has no impact on tumor recurrence. The aim of the present study was to determine whether SVI has an impact on the amount of blood retained in the resected lobe.

A non-randomized prospective study including 30 patients undergoing lobectomy for neoplasms. Group A-1'st had all lobar arteries ligated before interruption of the lobar vein and group V-1'st had a reverse sequence. Generous exclusion criteria were used, so as to include only patients with straightforward lobectomy, attempting to isolate SVI as the only factor that could affect blood loss. Lobar weight was recorded immediately after lobectomy. All ligatures and staplers were removed; blood drained from the lobe, collected and measured, and thereafter the lobe was weighed again.

Sixteen patients entered group A-1'st and 14 group V-1'st. The groups were similar in age, sex, body surface, histology, prior therapy, stage, FEV1%, length of operation, and number of segments resected. The amount of blood drained from the lobe was 31.4+/-13 and 34.2+/-14.8ml in group A-1'st and V-1'st, respectively. The lobar weights before and after blood drainage were 177.6+/-56.9, 141.7+/-49.1g and 201.5+/-74.2, 161.6+/-69.7g, respectively. The amount of blood divided to the lobar weight was 0.178+/-0.052 in group A-1'st and 0.177+/-0.099 in group V-1'st. All of these figures did not differ statistically. No patient required blood transfusion during or after surgery.

In straightforward lobectomy the amount of blood retained in the resected lobe is small. This amount is not affected by the sequence of hilar vessel interruption.