Original research article: An advanced bipolar device helps reduce the rate of postoperative pancreatic fistula in laparoscopic gastrectomy for gastric cancer patients: A propensity score-matched analysis

Abstract

Background: Advanced bipolar devices (ABD; e.g. LigaSureTM) have a lower blade temperature than ultrasonically activated devices (USAD; e.g. Harmonic® and SonicisionTM) 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, this study aimed to compared the efficacy and safety of ABD and USAD in laparosopic gastrectomy for gastric cancer patients.Methods: A retrospective cohort study was conducted in 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 grade ≥II POPF, were compared between an ABD and a 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 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 USAD was the only independent risk factor with a considerably high OR for the occurrence of POPF (USAD/ABD, OR 8.38, P = 0.0466).Conclusion: ABD may contribute to improving the safety of laparoscopic gastrectomy for gastric cancer patients.