A national analysis of open versus minimally invasive thymectomy for stage I–III thymic carcinoma

Abstract

OBJECTIVES The oncological efficacy of minimally invasive thymectomy for thymic carcinoma is not well characterized. We compared overall survival and short-term outcomes between open and minimally invasive surgical (video-assisted thoracoscopic and robotic) approaches using the National Cancer Database. METHODS Perioperative outcomes and overall survival of patients who underwent open versus minimally invasive thymectomy for Masaoka stage I–III thymic carcinoma from 2010 to 2015 in the National Cancer Database were evaluated using propensity score-matched analysis and multivariable Cox proportional hazards modelling. Outcomes by surgical approach were assessed using an intent-to-treat analysis. RESULTS Of the 216 thymectomies that were evaluated, 43 (20%) were performed with minimally invasive techniques (22 video-assisted thoracoscopic and 21 robotic). The minimally invasive approach was associated with a shorter median length of stay when compared to the open approach (3 vs 5 days, P < 0.001). In the propensity score-matched analysis of 30 open and 30 minimally invasive thymectomies, the minimally invasive group did not differ significantly in median length of stay (3 vs 4.5 days, P = 0.27), 30-day readmission (P = 0.13), 30-day mortality (P = 0.60), 90-day mortality (P = 0.60), margin positivity (P = 0.39) and 5-year survival (78.6% vs 54.6%, P = 0.15) when compared to the open group. CONCLUSIONS In this national analysis, minimally invasive thymectomy for stage I–III thymic carcinoma was found to have no significant differences in short-term outcomes and overall survival when compared to open thymectomy.

Early Postoperative Results after Thymectomy for Thymic Cancer: A Single‐Institution Experience

“…In fact, length of surgery is inconsistently reported throughout the literature and MIS does not always guarantee faster surgical operations. Marulli and colleagues [5] comparing transsternal and robotic thymectomy found a significantly longer surgical time for patients treated with the latter technique, that become non‐significant after a propensity score match; similar results were more recently reported by Hurd [19] in a cohort of patients affected by thymic carcinomas. On the other hand, Casiraghi [14] found a significant longer surgical time in open procedures compared to robotic ones.…”

Role of fluorine-18-fluorodeoxyglucose positron emission tomography in selecting candidates for a minimally invasive approach for thymic epithelial tumour resection

“…Among these 14 patients with thymic carcinoma, 35.7% ( n = 5) were pathologically upstaged. Although MIA for thymectomy has been widely accepted, there is little evidence to support MIA for thymic cancer because MIA is indicated in a minority of patients with thymic carcinoma [ 19 ]. Moreover, the evidence supporting routine LN dissection is also insufficient and controversial, as National Comprehensive Cancer Network guidelines do not mention the indications for LN dissection [ 3 ].…”

Effect of open versus video-assisted thoracoscopy on perioperative outcomes and survival for cases of thymic carcinomas and thymic neuroendocrine tumors

“…However, it is worth noting that there were only 22 patients with VATS in this cohort, and that, due to the limitations of the database, some important information such as surgical methods, diagnosis of myasthenia gravis , postoperative complications, and histological classification of thymic cancer, was missing. As well, 54.2% of the study cohort were patients with early-stage malignancies of Masaoka stages I–II, and a very small proportion were of Asian ethnicity [ 11 ]. Recently, Gu et al focused on MIT for the treatment of T2-3NxM0 thymic malignancies, and their data suggested that it could be safely performed in carefully selected patients.…”

“…Another study used data from the National Cancer Database (NCDB) to compare short-term results and overall survival following open versus minimally invasive thymectomy (MIT) procedures for Masaoka-Koga stage I–III TCs. It is worth noting, however, that only 22 of the patients in that study underwent VATS [ 11 ]. Gu et al explored the impacts of different surgical methods for locally advanced resectable TETs on patient prognoses, including 23 minimally invasive TC and TNET tumors [ 12 ].…”