Vessels first and tumour-bed lavage: source arguments

Venous and arterial ligation have different aims.

Early venous ligation aims to limit tumour cells escaping through venous drainage. Early arterial ligation aims to reduce blood flow through the tumour.

Tumour-bed lavage has two sides as well. Irrigation may dilute and wash away residual or exfoliated tumour cells. This could leave fewer cells able to implant locally. But the same fluid can spread exfoliated cells around the surgical field, especially within a body cavity.

These are the reasons for and against the techniques. They do not give a measured reduction in local recurrence.

References

redrawn from my surgical study notes based on Johnston and Tobias.