Department of Surgery I, School of Medicine, University of Occupational and Environmental Health Japan, 1-1 Iseigaoka, Yahatanishi ward, Kitakyushu, Fukuoka, 807-8555, Japan.
Langenbecks Arch Surg. 2022 Dec;407(8):3479-3486. doi: 10.1007/s00423-022-02692-5. Epub 2022 Oct 1.
Advanced bipolar devices (ABD; e.g., LigaSure™) have a lower blade temperature than ultrasonically activated devices (USAD; e.g., Harmonic® and Sonicision™) during activation, potentially enabling accurate lymph node dissection with less risk of postoperative pancreatic fistula (POPF) due to pancreatic thermal injury in laparoscopic gastrectomy. Therefore, we compared the efficacy and safety of ABD and USAD in laparoscopic gastrectomy for gastric cancer patients.
A retrospective cohort study was conducted on patients who underwent laparoscopic distal gastrectomy (LDG) between August 2008 and September 2020. A total of 371 patients were enrolled, and short-term surgical outcomes, including the incidence of ISGPF grades B and C POPF, were compared between ABD and USAD. The risk factors for POPF in LDG were investigated by univariate and multivariate analyses.
A propensity score-matching algorithm was used to select 120 patients for each group. The POPF rate was significantly lower (0.8 vs. 9.2%, p < 0.001), the morbidity rate was lower (13.3 vs. 28.3%, p < 0.001), the length of postoperative hospitalization was shorter (14 vs. 19 days, p < 0.001), and the lymph node retrieval rate was higher (34 vs. 26, p < 0.001) with an ABD than with a USAD. There were no mortalities in either group. A multivariate analysis showed that a USAD was the only independent risk factor with a considerably high odds ratio for the occurrence of POPF (USAD/ABD, odds ratio 8.38, p = 0.0466).
An ABD may improve the safety of laparoscopic gastrectomy for gastric cancer patients.
在激活过程中，高级双极器械（ABD；例如 LigaSure™）的刀头温度低于超声激活器械（USAD；例如 Harmonic®和 Sonicision™），这可能使腹腔镜胃癌手术中淋巴结清扫更准确，同时由于胰腺热损伤导致术后胰瘘（POPF）的风险降低。因此，我们比较了 ABD 和 USAD 在腹腔镜胃癌手术中的疗效和安全性。
对 2008 年 8 月至 2020 年 9 月间接受腹腔镜远端胃切除术（LDG）的患者进行回顾性队列研究。共纳入 371 例患者，比较 ABD 和 USAD 两组患者短期手术结局，包括 ISGPF 分级 B 和 C 型 POPF 的发生率。采用单因素和多因素分析探讨 LDG 中 POPF 的危险因素。
采用倾向评分匹配算法为每组选择 120 例患者。ABD 组的 POPF 发生率显著较低（0.8% vs. 9.2%，p<0.001），发病率较低（13.3% vs. 28.3%，p<0.001），术后住院时间较短（14 天 vs. 19 天，p<0.001），淋巴结检出率较高（34 个 vs. 26 个，p<0.001）。两组均无死亡病例。多因素分析显示，USAD 是发生 POPF 的唯一独立危险因素，其发生 POPF 的优势比（OR）较高（USAD/ABD，OR 8.38，p=0.0466）。
ABD 可能提高腹腔镜胃癌手术的安全性。
