Abstract
Purpose
The use of video-assisted thoracoscopic surgery (VATS) in patients with thymoma remains controversial. We sought to evaluate the perioperative and oncological outcomes after VATS resection for stage I and II thymoma and to compare the outcomes with those obtained after median sternotomy (MST).
Methods
Between 1991 and 2007, a total of 140 patients with stage I and II thymoma underwent surgery at the Chang Gung Memorial Hospital. Of them, 58 underwent MST, 61 VATS, and 21 thoracotomy. Using a propensity score based on four variables (myasthenia gravis, tumor size on CT images, age, and Masaoka stage), 48 VATS-treated patients were matched to 48 patients who received MST. Outcomes compared included perioperative complications, length of stay, tumor recurrence, and survival.
Results
No operative deaths occurred in this study. VATS was associated with fewer intraoperative blood loss, and more patients in the VATS group were extubated in the operating room after surgery compared with the MST group (37.5 vs. 12.5 %, respectively, P = 0.005). The mean length of stay was shorter in the VATS group than in the MST group (5.8 vs. 7 days, respectively; P = 0.008). After a median follow-up of 53 months, five patients developed recurrent tumors (four pleural and one pericardial). No statistically significant differences were found in the 5-year survival rates between the two study groups.
Conclusions
VATS appears feasible for patients with stage I and II thymoma and is associated with better perioperative outcomes than MST. The oncological outcomes are also similar.
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References
Tomaszek S, Wigle DA, Keshavjee S, Fischer S. Thymomas: review of current clinical practice. Ann Thorac Surg. 2009;87:1973–80.
Margaritora S, Cesario A, Cusumano G, et al. Thirty-five-year follow-up analysis of clinical and pathologic outcomes of thymoma surgery. Ann Thorac Surg. 2010;89:245–52.
Wright CD, Wain JC, Wong DR, et al. Predictors of recurrence in thymic tumors: importance of invasion, World Health Organization histology, and size. J Thorac Cardiovasc Surg. 2005;130:1413–21.
Davenport E, Malthaner RA. The role of surgery in the management of thymoma: a systematic review. Ann Thorac Surg. 2008;86:673–84.
Ruckert JC, Walter M, Muller JM. Pulmonary function after thoracoscopic thymectomy versus median sternotomy for myasthenia gravis. Ann Thorac Surg. 2000;70:1656–61.
Agasthian T, Lin SJ. Clinical outcome of video-assisted thymectomy for myasthenia gravis and thymoma. Asian Cardiovasc Thorac Ann. 2010;18:234–9.
Takeo S, Tsukamoto S, Kawano D, Katsura M. Outcome of an original video-assisted thoracoscopic extended thymectomy for thymoma. Ann Thorac Surg. 2011;92:2000–5.
Roviaro G, Varoli F, Nucca O, Vergani C, Maciocco M. Videothoracoscopic approach to primary mediastinal pathology. Chest. 2000;117:1179–83.
Cheng YJ, Kao EL, Chou SH. Videothoracoscopic resection of stage II thymoma: prospective comparison of the results between thoracoscopy and open methods. Chest. 2005;128:3010–2.
Pennathur A, Qureshi I, Schuchert MJ, et al. Comparison of surgical techniques for early-stage thymoma: feasibility of minimally invasive thymectomy and comparison with open resection. J Thorac Cardiovasc Surg. 2011;141:694–701.
Odaka M, Akiba T, Yabe M, et al. Unilateral thoracoscopic subtotal thymectomy for the treatment of stage I and II thymoma. Eur J Cardiothorac Surg. 2010;37:824–6.
Yim AP. Video-assisted thoracoscopic resection of anterior mediastinal masses. Int Surg. 1996;81:350–3.
Cirino LM, Milanez de Campos JR, Fernandez A, et al. Diagnosis and treatment of mediastinal tumors by thoracoscopy. Chest. 2000;117:1787–92.
Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg. 2003;76:878–84.
Zisis C, Rontogianni D, Tzavara C, et al. Prognostic factors in thymic epithelial tumors undergoing complete resection. Ann Thorac Surg. 2005;80:1056–62.
Lucchi M, Davini F, Ricciardi R, et al. Management of pleural recurrence after curative resection of thymoma. J Thorac Cardiovasc Surg. 2009;137:1185–9.
Girard N, Mornex F, Van Houtte P, Cordier JF, Van Schil P. Thymoma: a focus on current therapeutic management. J Thorac Oncol. 2009;4:119–26.
Ciccone AM, Rendina EA. Treatment of recurrent thymic tumors. Semin Thorac Cardiovasc Surg. 2005;17:27–31.
Lee CY, Kim DJ, Lee JG, Park IK, Bae MK, Chung KY. Bilateral video-assisted thoracoscopic thymectomy has a surgical extent similar to that of transsternal extended thymectomy with more favorable early surgical outcomes for myasthenia gravis patients. Surg Endosc. 2011;25:849–54.
Kondo K, Monden Y. Myasthenia gravis appearing after thymectomy for thymoma. Eur J Cardiothorac Surg. 2005;28:22–5.
Tseng Y-C, Hsieh C-C, Huang H-Y, et al. Is thymectomy necessary in nonmyasthenic patients with early thymoma? J Thorac Oncol. 2013;8(7):952–58.
Onuki T, Ishikawa S, Iguchi K, et al. Limited thymectomy for stage I or II thymomas. Lung Cancer. 2010;68:460–5.
Acknowledgment
This work was supported by grants CMRPG3C1281 from Chang Gung Memorial Hospital, Taiwan, Republic of China.
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The authors declare no conflict of interest.
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Chao, YK., Liu, YH., Hsieh, MJ. et al. Long-Term Outcomes After Thoracoscopic Resection of Stage I and II Thymoma: A Propensity-Matched Study. Ann Surg Oncol 22, 1371–1376 (2015). https://doi.org/10.1245/s10434-014-4068-9
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DOI: https://doi.org/10.1245/s10434-014-4068-9