Robotic Resection of 3 Cm and Larger Thymomas is Associated with Low Perioperative Morbidity and Mortality

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> The approach to thymoma resection has usually been determined by tumor size, although established guidelines do not exist. Minimally invasive approaches have been limited to tumors smaller than 5 cm, although 3 cm has been the suggested cutoff for performing an adequate oncologic procedure. No study has compared the perioperative outcomes of patients with 3 cm or larger tumors resected robotically versus sternotomy. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> We reviewed patients who underwent resection of 3 cm or larger thymomas from 2004 to 2014. Patients were divided based on approach: robotic and open thymectomy/thymomectomy. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Forty patients with tumors ranging from 3 to 13 cm were evaluated, 23 robotic and 17 open. Patient and tumor characteristics were similar. An R0 resection was primarily achieved: robotic, 91% (21/23); and open, 88% (15/17); P = 0.832. Adjuvant radiation rates were statistically equivalent: robotic, 17% (4/23) versus open, 41% (7/17); P = 0.191. Major postoperative complications were comparable: robotic, 4% (1/23) versus open, 29% (4/17); P = 0.184. Median chest tube duration was shorter for robotic (1 day) versus open (3 days); P = 0.001. The robotic approach had a shorter median intensive care unit stay compared to open (0 days vs 1day); P = 0.024. The median hospital stay was shorter for robotic (2 days) versus open (5 days); P &lt; 0.001. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> In 3 cm or larger thymomas, robotic thymectomy is feasible based on the ability to achieve a complete resection with similar adjuvant radiation therapy rates. Perioperatively, robotic thymectomy is associated with lower morbidity; and shorter chest tube duration, intensive care unit stay, and hospital stay compared to open. However, on-cologic outcomes are immature and require prolonged surveillance. </jats:p></jats:sec>

Robotic thoracic surgery for resection of thymoma and tumors of the thymus: technical development and initial experience

“…As shown in previous publications, resection of large thymic tumors by robotic surgery is safe and effective. (12,23) In our study, large tumors (largest diameter: 12.5 cm) were resected, which corroborates the hypothesis that size should not be considered an absolute contraindication to the method. Currently, the major limitation in cases of mediastinal lesions is the invasion of vascular structures, because the use of robots has not been proven safe in those cases.…”

“…If the surgical specimens showed tumor-free margins or margins coincident with structures that precluded further resection, such as the sternum, pleural surface, or pericardium, the resection was categorized as curative (R0). (12) The thymomas were staged according to the Masaoka-Koga classification. (13)…”

Robotic Thymectomy Is Feasible for Large Thymomas: A Propensity-Matched Comparison

“…Pathologic reports were reviewed to assess tumor size, histologic characteristics based on World Health Organization (WHO) classification, Masaoka stage, margin status, and resection of adjacent structures. An R0 resection was defined as absence of tumor at the resection margin, or when a tumor microscopically involved the anterior margin, in an area where no further tissue could be resected, including the underside of sternum, or inside of the pericardium, or open pleural space, as previously described [12]. Operative reports were reviewed to ascertain the side of access, resection of additional structures, and specific reasons for conversion in individual instances.…”

“…Over the past decade, the RAT approach has been offered to patients with large thymomas [10][11][12]. However, there has been a paucity of data.…”

Consensus statement on definitions and nomenclature for robotic thoracic surgery

“…Extraction incisions were used uniformly and created by extending one of the incisions or occasionally using a lower and wider rib space for larger masses. Table 2 [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] lists the articles that met our criteria for resection of posterior mediastinal pathology and for anterior mediastinal pathology.…”