Proximal ligation of the pulmonary vein stump to prevent postoperative cerebral infarction after a lobectomy†.

Objectives: Our goal was to assess whether proximal ligation of the pulmonary vein stump (PVS) outside the pericardium reduces the incidence of postoperative cerebral infarction (PCI) after a lobectomy.

Methods: A single-institution retrospective review was conducted of 683 patients undergoing a lobectomy for lung cancer, metastatic lung tumours and benign diseases. Associations among PCI within 90 days, ligation of the PVS and clinicopathological features were analysed. Effects of PVS ligation on PCI were assessed using multivariable regression. PVS length measured on three-dimensional computed tomographic angiography was compared between the non-ligation and ligation groups.

Results: The non-ligation and ligation groups included 356 (January 2010-March 2018) and 327 patients (April 2018-November 2023), respectively. Seven non-ligation group patients (1.96%) had PCIs [3 in a left upper lobectomy (LUL) and left lower lobectomy (LLL) and 1 in a right lower lobectomy]; no ligation group patients suffered PCIs (P = 0.016). Univariable analysis showed that LUL, LLL, chronic kidney disease (CKD), heart failure, cardiovascular disease and PVS ligation were significantly associated with PCIs. Multivariable analysis demonstrated that PVS ligation (P = 0.034) was correlated with decreased PCI and LUL (P = 0.011), LLL (P = 0.010) and CKD (P = 0.004) with increased PCIs. After ligation, PVS length was shortened in each lobe in a subset analysis of 109 patients.

Conclusions: Proximal ligation of the PVS outside the pericardium may be an option to prevent a PCI during a lobectomy. Patients with CKD and those undergoing left-sided lobectomy are at higher risk for PCI and may benefit from more intensive management.