Wei S, et al. - Through a randomized clinical trial of 86 patients who were randomly allocated to receive vein-first vs artery-first ligation during surgery from December 2016 to March 2018, researchers assessed patients with non–small cell lung cancer for the outcomes of various sequences of vessel ligation during surgery on the dissemination of tumor cells and survival. An incremental change in folate receptor-positive circulating tumor cells (FR+CTCs) was seen in 26 of 40 and 12 of 38 patients in the artery-first group and the vein-first group, respectively, following surgery. For increasing FR+CTC during surgery, multivariate analysis validated that the artery-first procedure was a risk factor. The propensity-matched analysis involved 420 subjects. For 5-year overall survival, disease-free survival, and lung cancer-specific survival, the vein-first group had notably better outcomes vs the artery-first group. For worse 5-year overall survival, disease-free survival, and lung cancer-specific survival, multivariate analyses showed that the artery-first procedure was a prognostic factor. In non–small cell lung cancer cases, ligating effluent veins first during surgery may decrease tumor cell dissemination and enhance survival outcomes.