Kazunori Shibao1, Shinsaku Honda2, Yasuhiro Adachi2, Shiro Kohi2, Yuzan Kudou2, Nobutaka Matayoshi2, Nagahiro Sato2, Keiji Hirata2. 1. Department of Surgery I, School of Medicine, University of Occupational and Environmental Health Japan, 1-1 Iseigaoka, Yahatanishi ward, Kitakyushu, Fukuoka, 807-8555, Japan. shibao@med.uoeh-u.ac.jp. 2. Department of Surgery I, School of Medicine, University of Occupational and Environmental Health Japan, 1-1 Iseigaoka, Yahatanishi ward, Kitakyushu, Fukuoka, 807-8555, Japan.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: An ABD may improve the safety of laparoscopic gastrectomy for gastric cancer patients.
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: An ABD may improve the safety of laparoscopic gastrectomy for gastric cancer patients.
Authors: Salah-Eddin Al-Batran; Nils Homann; Claudia Pauligk; Thorsten O Goetze; Johannes Meiler; Stefan Kasper; Hans-Georg Kopp; Frank Mayer; Georg Martin Haag; Kim Luley; Udo Lindig; Wolff Schmiegel; Michael Pohl; Jan Stoehlmacher; Gunnar Folprecht; Stephan Probst; Nicole Prasnikar; Wolfgang Fischbach; Rolf Mahlberg; Jörg Trojan; Michael Koenigsmann; Uwe M Martens; Peter Thuss-Patience; Matthias Egger; Andreas Block; Volker Heinemann; Gerald Illerhaus; Markus Moehler; Michael Schenk; Frank Kullmann; Dirk M Behringer; Michael Heike; Daniel Pink; Christian Teschendorf; Carmen Löhr; Helga Bernhard; Gunter Schuch; Volker Rethwisch; Ludwig Fischer von Weikersthal; Jörg T Hartmann; Michael Kneba; Severin Daum; Karsten Schulmann; Jörg Weniger; Sebastian Belle; Timo Gaiser; Fuat S Oduncu; Martina Güntner; Wael Hozaeel; Alexander Reichart; Elke Jäger; Thomas Kraus; Stefan Mönig; Wolf O Bechstein; Martin Schuler; Harald Schmalenberg; Ralf D Hofheinz Journal: Lancet Date: 2019-04-11 Impact factor: 79.321
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