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Spread of malignant cells in the surgical margin with stapled excision of lung cancer: comparison of aggressive clump and less traumatic jaw closure type staplers.

BACKGROUND
During stapled excision of lung cancer tissue, malignant cells can spread in the surgical margin. Stapling methods can be classified as aggressive clumping (AC) and less traumatic jaw closing (LTJC) types, thus the ratio of malignant margins may differ between stapler types.


METHODS
The malignant status of the stapled margin was retrospectively investigated in 112 cases using a cytology technique. Stapler type, maximum tumor diameter, distance from surgical margin, thoracotomy type, and tumor location were used as variables. In addition, clinical results of excision cases were assessed.


RESULTS
The ratio of malignant margins was 22/54 (41 %) in the AC group and 11/58 (19 %) in the LTJC group ( P = 0.01). Multivariate analysis revealed that the stapling method and tumor location were an independently significant factor. Surgical margin recurrence occurred only in 4 (57 %) of 7 cases with malignant margin.


CONCLUSIONS
The AC type method showed a greater potential to spread malignant cells, thus there seems to be a higher possibility of regional relapse with that technique.