Gabryel Piotr, Roszak Magdalena, Skrzypczak Piotr, Gabryel Anna, Zielińska Dominika, Sielewicz Magdalena, Campisi Alessio, Kasprzyk Mariusz, Piwkowski Cezary
Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland.
Department of Computer Science and Statistics, Poznan University of Medical Sciences, Rokietnicka 7 Street, 60-806 Poznan, Poland.
J Clin Med. 2023 May 31;12(11):3780. doi: 10.3390/jcm12113780.
The outcomes of non-small cell lung cancer surgery are influenced by the quality of lymphadenectomy. This study aimed to evaluate the impact of different energy devices on lymphadenectomy quality and identify additional influencing factors. This secondary analysis of the prospective randomized trial data (clinicaltrials.gov: NCT03125798) compared patients who underwent thoracoscopic lobectomy with the LigaSure device (study group, = 96) and monopolar device (control group, = 94). The primary endpoint was the lobe-specific mediastinal lymphadenectomy. Lobe-specific mediastinal lymphadenectomy criteria were met in 60.4% and 38.3% of patients in the study and control groups, respectively ( 0.002). In addition, in the study group, the median number of mediastinal lymph node stations removed was higher (4 vs. 3, 0.017), and complete resection was more often achieved (91.7% vs. 80.9%, 0.030). Logistic regression analysis indicated that lymphadenectomy quality was positively associated with the use of the LigaSure device (OR, 2.729; 95% CI, 1.446 to 5.152; 0.002) and female sex (OR, 2.012; 95% CI, 1.058 to 3.829; 0.033), but negatively associated with a higher Charlson Comorbidity Index (OR, 0.781; 95% CI, 0.620 to 0.986; 0.037), left lower lobectomy (OR, 0.263; 95% CI, 0.096 to 0.726; 0.010) and middle lobectomy (OR, 0.136; 95% CI, 0.031 to 0.606, 0.009). This study found that using the LigaSure device can improve the quality of lymphadenectomy in lung cancer patients and also identified other factors that affect the quality of lymphadenectomy. These findings contribute to improving lung cancer surgical treatment outcomes and provide valuable insights for clinical practice.
非小细胞肺癌手术的预后受淋巴结清扫质量的影响。本研究旨在评估不同能量设备对淋巴结清扫质量的影响，并确定其他影响因素。这项对前瞻性随机试验数据（clinicaltrials.gov：NCT03125798）的二次分析比较了接受使用LigaSure设备的胸腔镜肺叶切除术的患者（研究组，n = 96）和接受单极设备的患者（对照组，n = 94）。主要终点是肺叶特异性纵隔淋巴结清扫术。研究组和对照组分别有60.4%和38.3%的患者符合肺叶特异性纵隔淋巴结清扫标准（P = 0.002）。此外，在研究组中，切除的纵隔淋巴结站中位数更高（4比3，P = 0.017），并且更常实现完全切除（91.7%比80.9%，P = 0.030）。逻辑回归分析表明，淋巴结清扫质量与使用LigaSure设备（比值比，2.729；95%置信区间，1.446至5.152；P = 0.002）和女性性别（比值比，2.012；95%置信区间，1.058至3.829；P = 0.033）呈正相关，但与较高的Charlson合并症指数（比值比，0.781；95%置信区间，0.620至0.986；P = 0.037）、左下肺叶切除术（比值比，0.263；95%置信区间，0.096至0.726；P = 0.010）和中叶切除术（比值比，0.136；95%置信区间，0.031至0.606，P = 0.009）呈负相关。本研究发现，使用LigaSure设备可提高肺癌患者的淋巴结清扫质量，并确定了其他影响淋巴结清扫质量的因素。这些发现有助于改善肺癌手术治疗效果，并为临床实践提供有价值的见解。
