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Objective:Ultrasonically activated shears (UAS) have been applied in open gastric surgeries with no or little evidence.It was previously reported about the surgical outcome and effectiveness of UAS based on a randomized controlled trial of 256 patients with gastric cancer.We aimed to clarify the long-term oncological safety of the use of UAS in the aspect of overall survival and recurrence.Methods:Gastric cancer patients who underwent gastrectomy with D2 lymph node dissection were enrolled and randomly assigned to either the conventional surgery group (n=125) or the UAS group (n=128).Survival,recurrence and long-term postoperative complications were compared between the two groups.The median follow-up period was 56 months.Results:Gastric cancer-related death was higher in patients of the UAS group compared with the conventional group (P=0.019).Overall survival rates stratified by stage were not significantly different between the two groups (P=0.170).Disease-free survival rates stratified by stage and recurrence-free survival rates of gastric cancer were similar between the conventional group and the UAS group (P=0.313 and 0.199,respectively).The postoperative complication rate was not significantly different between the groups (P=1.000).Conclusions:It is suggested that the use of UAS in gastrectomy for gastric cancer showed oncologically acceptable safety compared with conventional electric instruments even in long-term period.