Comparing robotic and trans-sternal thymectomy for early-stage thymoma: a propensity score-matching study†

Abstract

Robotic thymectomy for early-stage thymoma is a technically safe and feasible procedure with low complication rate and shorter hospital stay compared to the trans-sternal approach. Cost analysis revealed lower expenses for the robotic procedure due to the reduced hospital stay. The oncological outcomes seemed comparable, but longer follow-up is needed.

Results of Robotic Thymectomy Performed in Myasthenia Gravis Patients Older Than 60 Years at Onset

“…The rate of open conversion in our series was 1.5%, which was similar to that (2.4%, 3.1%) reported in previous publications (19,20). The only conversion in our series occurred in a 73 years male with a 7.7cm Masaoka-Koga stage III thymoma because of the injury of the left innominate vein.…”

A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy

“…Operative time ( Figure 3A) was reported in all studies except one (23). Of those, 12 reported data in sufficient detail for metaanalysis (22,24,25,(27)(28)(29)(30)(31)(32)35,37,38), which showed equivalent operative time for robotic thymectomy vs. open surgery (WMD: 6.73; 95% CI: −21.20, 34.66, P=0.64) with significant heterogeneity (P<0.00001, I 2 =97%), perhaps due to differences in definitions of operative time between studies. Eight studies reported on intraoperative blood loss (EBL) (27)(28)(29)31,32,36,37,39), of these, seven reported EBL in enough detail for pooled analysis ( Figure 3B) (27)(28)(29)31,36,37,39), which showed significantly lower blood loss in the robotic group (WMD: −173.03; 95% CI: −305.90, −40.17, P=0.01), but with significant heterogeneity (P<0.00001, I 2 =99%) due to large variance in the magnitude of the robotic benefit; all seven papers reported significantly lower EBL for the robotic group.…”

“…Several of the studies had a high risk of selection bias due to historical controls (24,32,34,36,37), differences in criteria for patient selection (22,33), or patient characteristic differences between groups (23). Studies that performed propensity score matching for outcomes of interest were considered at low risk for selection bias (25,(27)(28)(29)(30)35), as were the papers by Qian et al (31) and Ye et al (39), due to contemporary controls, the same selection criteria, and no differences in patient characteristics. Most of the studies were rated as unknown or high risk for performance bias due to a lack of information provided on surgical techniques and care pathways.…”

“…The paper by Weksler et al (36) was assessed as having a high risk of detection bias because the authors specifically mentioned not being able to obtain accurate operative times for the transsternal group and did not report all of the same outcomes for each group. All of the other studies were rated as unclear risk due to a lack of information (22,24,26,28,35,39), or as low risk of detection bias due to prospectively collected data (27,33,34,37), data entry into a registry (23), precise definitions of outcomes provided (25,29,30,38), or because any missing definitions were unlikely to affect outcomes (31,32). The study by Weksler et al (36) was also assessed as high risk for attrition bias because of incomplete data that was likely due to intervention type.…”

“…Only one study reported on blood transfusions (R 0% vs. O 0%, ns) (38). Length of hospital stay (LOS) was reported in 13 publications (22,24,25,(27)(28)(29)(30)(31)(32)(35)(36)(37)(38). Pooled analysis showed a significantly shorter hospital stay ( Figure 3C) in the robotic group (WMD: −2.78; 95% CI: −3.22, −2.33, P<0.00001), with significant heterogeneity (P=0.0002, I 2 =67%), which appears to be due to variability in the degrees of benefit in the robotic group as all studies reported a shorter LOS in the robotic group.…”