Kamimura Go, Aoki Masaya, Imamura Satomi, Morizono Shoichiro, Tokunaga Takuya, Umehara Tadashi, Harada-Takeda Aya, Maeda Koki, Nagata Toshiyuki, Ueda Kazuhiro
Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan.
Interdiscip Cardiovasc Thorac Surg. 2025 Aug 5;40(8). doi: 10.1093/icvts/ivaf171.
Two major types of stapling devices exist: those with disposable built-in knives and those with nondisposable built-in knives. This study investigated whether the stapler type influences the incidence of local recurrence, including margin recurrence and pleural dissemination, after curative sublobar resection for lung cancer.
We retrospectively reviewed patients who underwent sublobar resection at our institution between 2010 and 2021. We compared disease-free survival, overall survival, and local recurrence between procedures using a stapler with a disposable knife and those using a stapler with a nondisposable knife.
A total of 269 patients were included: 84 were treated with the disposable-knife stapler and 185 with the nondisposable-knife stapler. Local recurrence occurred in 22 of 269 patients (8.2%), including 9 of 84 (10.7%) in the disposable group and 13 of 185 (7.0%) in the nondisposable group (P = .72). Patients who developed local recurrence tended to be older, male, have a smoking history, squamous cell carcinoma, absence of a ground-glass component, positive stapling cartridge cytology, partial resection, right lower lobe tumours, elevated carcinoembryonic antigen, and higher maximum standardized uptake values. In a propensity score-matched study (78 patients per group), no significant differences in disease-free survival, overall survival, or local recurrence were detected between the stapler types.
No statistically significant differences in oncological outcomes were observed between stapler types in this retrospective study; however, the absence of a significant difference does not rule out a real effect. Further large-scale research is warranted.
存在两种主要类型的吻合器：带有一次性内置刀片的和不带有一次性内置刀片的。本研究调查了在肺癌根治性亚肺叶切除术后，吻合器类型是否会影响局部复发的发生率，包括切缘复发和胸膜播散。
我们回顾性分析了2010年至2021年间在我院接受亚肺叶切除术的患者。我们比较了使用一次性刀片吻合器和使用非一次性刀片吻合器的手术之间的无病生存期、总生存期和局部复发情况。
共纳入269例患者：84例接受一次性刀片吻合器治疗，185例接受非一次性刀片吻合器治疗。269例患者中有22例（8.2%）发生局部复发，其中一次性刀片组84例中有9例（10.7%），非一次性刀片组185例中有13例（7.0%）（P = 0.72）。发生局部复发的患者往往年龄较大、为男性、有吸烟史、患鳞状细胞癌、无磨玻璃成分、吻合钉仓细胞学检查阳性、行部分切除、肿瘤位于右下叶、癌胚抗原升高以及最大标准化摄取值较高。在一项倾向评分匹配研究（每组78例患者）中，未检测到两种吻合器类型在无病生存期、总生存期或局部复发方面存在显著差异。
在这项回顾性研究中，未观察到不同类型吻合器在肿瘤学结局方面存在统计学上的显著差异；然而，无显著差异并不排除实际影响。有必要进行进一步的大规模研究。
