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

## TL;DR

This study found no significant difference in cancer recurrence after lung surgery based on the type of stapling device used.

## Contribution

The study is one of the first to compare oncological outcomes based on stapler type in sublobar lung resections.

## Key findings

- Local recurrence rates were 10.7% for disposable-knife staplers and 7.0% for nondisposable-knife staplers.
- No significant differences in disease-free or overall survival were found between stapler types.
- Older age and smoking history were associated with higher local recurrence risk.

## Abstract

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.

Automatic stapling devices that are frequently used in the general thoracic surgery field can be divided into 2 types depending on their structure: the nondisposable knife type, in which only the staple is replaced (Figure 1A), and the disposable knife type, in which the staple and knife are replaced (Figure 1B).