Long‐term outcomes of robot‐assisted radical thymectomy for large thymomas: A propensity matched analysis

Abstract

Background The aim of this study was to evaluate the long‐term results of robot‐assisted (RATS) thymectomy in the treatment of large thymomas, defined as larger than 5 cm. Methods We retrospectively reviewed 106 thymectomies from 2010 to 2020, creating two groups based on the surgical approach (open or RATS) and size. Kaplan‐Meier and Cox‐regression were used to estimate and identify risk factors of oncological outcomes. To perform a well‐balanced analysis, a propensity score matched (PSM) analysis was conducted for large thymomas. Results From 2015, we performed 54 RATS thymectomies: 53.7% (n = 29) for small and 46.3% (n = 25) for large thymomas. Conversions were similar and all patients had a complete resection. The overall (82% vs. 92%, p = 0.57) and disease‐free survival were comparable between RATS and open (92.5% vs. 93%, p = 0.67), outcomes confirmed after PSM for large thymomas. Conclusions RATS thymectomy could be considered a valid option in selected patients with large thymomas.

Perspectives on surgical treatment for thymic epithelial tumors: a narrative review

“…Robot-assisted thoracoscopic thymectomy is advantageous because it reduces the total volume of postoperative drainage and shortens the hospital stay ( 41 ). Robotic resection is safe and feasible even for thymic epithelial tumors up to 10 cm in size ( 42 - 44 ). However, owing to the lack of tactile and force feedback, safety has not been established for tumors with vascular invasion that require advanced techniques such as combined vascular resection and artificial vascular replacement.…”

Robotic Mediastinal Tumor Resections: Position and Port Placement

“…An assistant suction device can be used between the camera port and left arm port if necessary. A right-side approach has a wider field of view and larger working space [ 14 , 15 , 16 , 17 , 18 , 19 ], whereas a left-side approach potentially accesses more thymic tissue and allows easier visualization of the contralateral phrenic nerve [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Although it is controversial whether a left-side or right-side approach is better, several recent studies have reported using the left-side approach for extended thymectomy in patients with MG because it provides enhanced visualization and reduces the probability of phrenic nerve injury [ 21 , 25 , 27 , 28 ].…”

“…All cases considered resectable by VATS can be resected by RATS. Although large tumors less than around 10 cm are also resectable by robotic approach, malignant tumors invading the great vessels or chest wall are usually not indication for RATS but for open thoracotomy [ 26 , 34 ]. However, there are some reports of RATS thymectomy with combined resection of the brachiocephalic vein or superior vena cava [ 12 , 34 ].…”