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Perioperative outcomes of minimally invasive surgery for large malignant thymic epithelial tumors and for total thymectomy

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Abstract

Purpose

Minimally invasive surgery (MIS) for thymic tumors is now accepted widely, in line with improved surgical techniques; however, we occasionally encounter complicated cases of large tumors or of total thymectomy requiring prolonged operative duration or conversion to an open procedure (OP). We reviewed patients registered in a nationwide database to identify the technical feasibility of MIS for thymic epithelial tumors.

Methods

Data on patients treated surgically between 2017 and 2019 were extracted from the National Clinical Database of Japan. Clinical factors and operative outcomes were calculated by tumor diameter using trend analyses. Perioperative outcomes of MIS for non-invasive thymoma were investigated using propensity score-matched analyses.

Results

MIS was performed in 46.2% of the patients. The operative duration and conversion rate increased with the tumor diameter (p < .001). After propensity score-matching, operative duration and postoperative hospital stay were shorter (p < .001), and the transfusion rate was lower (p = .007) in patients who underwent MIS than in those who underwent OP for thymomas ≥ 5 cm. Among patients who underwent total thymectomy, blood loss was less (p < .001) and the postoperative hospital stay was shorter (p < .001) in those who underwent MIS than in those who underwent OP. There were no significant differences in postoperative complications and mortality.

Conclusions

MIS is technically feasible even for large non-invasive thymomas or for total thymectomy, although the operative duration and open conversion rate increase with the tumor diameter.

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Data availability

The data underlying this article were provided by National Clinical Database in Japan, with permission. Data will be shared on request to the corresponding author, with the permission of the office of National Clinical Database.

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Acknowledgements

We thank the data managers and physicians in the institutes participating in the NCD registry and the members of the NCD Committee of The Japanese Association of Chest Surgery. We also thank Ms. Chieko Fujimura (The University of Tokyo) for her help with this article.

Funding

This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kamigyo-Ku, Kyoto City, 602-8566, Japan

    Masayoshi Inoue

  2. Department of Healthcare Quality Assessment, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan

    Hiroyuki Yamamoto

  3. Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai City, Japan

    Yoshinori Okada

  4. Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka City, Japan

    Toshihiko Sato

  5. Department of Thoracic Surgery, University of Tsukuba, Tsukuba City, Japan

    Yukio Sato

  6. Department of General Thoracic Surgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan

    Kenji Suzuki

  7. Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba City, Japan

    Ichiro Yoshino

  8. Department of General Thoracic Surgery, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan

    Masayuki Chida

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  1. Masayoshi Inoue
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Correspondence to Masayoshi Inoue.

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Conflict of interest

Hiroyuki Yamamoto is affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo, which is a social collaboration department supported by grants from National Clinical Database, Johnson & Johnson K.K., and Nipro Co.

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Inoue, M., Yamamoto, H., Okada, Y. et al. Perioperative outcomes of minimally invasive surgery for large malignant thymic epithelial tumors and for total thymectomy. Surg Today 53, 1089–1099 (2023). https://doi.org/10.1007/s00595-023-02667-z

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  • DOI: https://doi.org/10.1007/s00595-023-02667-z

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