Local Recurrence After Sublobar Resection for Primary Lung Cancer: Does the Type of Stapling Device Matter?

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.