Pulmonary Fissure Development Affects The Number Of Stapler Cartridges In Complete Vats Lobectomy For Nsclc
Seokkee Lee, Jin Gu Lee, Dae Joon Kim.
Yonsei University College of Medicine, Seoul, Korea, Republic of.
OBJECTIVE: Video-assisted thoracic surgery (VATS) lobectomy has been considered an effective surgical treatment modality for patients with non-small cell lung cancer (NSCLC). The number of stapler cartridges required for VATS lobectomy and the factors affecting the number of stapler cartridges used have not been studied. This study investigated factors affecting the number of stapler cartridges used for VATS lobectomy.
METHODS: A retrospective analysis of patients who underwent complete VATS lobectomy for NSCLC between January 2013 and December 2015 was conducted. Number of stapler cartridges and pulmonary fissure development score (FDS) were collected prospectively for all these patients. Pulmonary fissure status was quantified by the FDS, and was divided into four groups based on the fissure sum average (FSA=summation of three FDS÷3). Surgeons were divided into two groups according to the preference for the methods of pulmonary fissure division.
RESULTS: 596 received complete VATS lobectomy. The average number of stapler cartridges used was 6.3 ± 2.4 (range, 2 - 17). Except for stapler cartilage used for diagnostic wedge resection, the number of stapler cartridges used for VATS lobectomy was 5.3 ± 1.9 (range, 2-14). The number of stapler cartridges to perform VATS lobectomy was higher in male (5.5 ± 1.9 vs. 5.0 ± 18, p=0.006), more than 70 years (5.5 ± 2.1 vs. 5.1 ± 1.7, p=0.038), upper or middle lobectomy (5.7 ± 1.9 vs. 4.1 ± 1.2, p<0.001), higher FSA (p<0.001), and in the surgeon group (5.6 ± 2.0 vs. 4.9 ± 1.6, p <0.001), which preferred to divide pulmonary fissure with stapler.
CONCLUSIONS: The number of stapler cartridges required to perform VATS lobectomy in patients with NSCLC is affected by gender, age, location of the tumor, degree of fissure development, and surgeon.
LEGEND Table. The number of stapler cartridges used for VATS lobectomy in 596 patients. Data are presented as number of patients (%) or mean ± standard deviation; p§, p-value for the number of stapler cartridges; FSA=summation of three fissure development score ÷ 3
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