Subxiphoid versus lateral intercostal approaches thoracoscopic thymectomy for non-myasthenic early-stage thymoma: A propensity score -matched analysis

Zhang, Louqian; Li, Ming; Jiang, Feng; Zhi, Zhang; Zhang, Qin; Xu, Lin

doi:10.1016/j.ijsu.2019.01.011

Cited by 36 publications

(32 citation statements)

References 18 publications

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“…Thymic tumors, e.g., thymoma, thymic hyperplasia and thymic squamous cell carcinoma, are primarily located at the anterior and superior mediastinum, where the space is limited yet rich in vital vessels and nerves. Thymectomy or extended thymectomy was the standard procedure for thymic tumors with or without endocrine or hematologic disorders, e.g., MG, SLE and AA [5,6]. The extent of resection by VATS through a subxiphoid route was comparable to that by open surgery through sternotomy, suggesting that VATS can achieve satisfactory resection and good prognosis.…”

Section: Discussionmentioning

confidence: 99%

Video-assisted thoracoscopic surgery is safe and reliable for large and invasive primary mediastinal tumors.

Yu¹,

Qin²

2020

Videosurgery and Other Miniinvasive Techniques

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Introduction: Video-assisted thoracoscopic surgery (VATS) was not considered for the treatment of primary mediastinal tumors of large sizes or with local invasion. Aim: To investigate the clinical outcomes of VATS for large and invasive mediastinal tumors. Material and methods: One hundred and thirteen patients with primary mediastinal tumors were treated by VATS. Twenty-nine patients had bulky tumors (diameter > 6 cm) and 5 patients had invasive tumors. Clinical data were documented and compared. Results: No patients suffered from any complications after VATS. No relapse or metastasis occurred in the patients with bulky tumors, while one patient with invasive thymoma suffered a relapse after VATS. The 2-year disease-free survival and overall survival in patients with bulky tumors were 100% and 100%, while those in patients with invasive tumors were 75% and 100%. There were no differences in hospital stay after VATS between the patients with bulky tumors and smaller tumors, nor between the patients with invasive tumors and non-invasive tumors. Patients with bulky tumors lost more blood than those with smaller tumors, while more blood loss occurred in patients with invasive tumors than non-invasive tumors. Longer operative time was needed for patients with bulky tumors and invasive tumors. Conclusions: Mediastinal tumors with large size or invasion should not be contraindicated for VATS. The prognosis of such patients treated with VATS was comparable to that of traditional open surgery. In summary, VATS is a safe and effective procedure for large and invasive mediastinal tumors.

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Section: Discussionmentioning

confidence: 99%

Video-assisted thoracoscopic surgery is safe and reliable for large and invasive primary mediastinal tumors.

Yu¹,

Qin²

2020

Videosurgery and Other Miniinvasive Techniques

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show abstract

“…The subxiphoid approach was introduced in 1999 by Kido et al [36] , paving the way for Hsu et al [37] , who first performed subxiphoid video-assisted thoracoscopic extended thymectomy in 2002. Since then, the subxiphoid approach has been used successfully and many techniques have been described according to the incision design: the uniportal or dual-port subxiphoid approach [38][39][40] , the subxiphoid and subcostal arch approach, subxiphoid robotic thymectomy [41,42] , and a combination of the transthoracic and subxiphoid approaches [43] .…”

Section: Subxiphoid Thymectomymentioning

confidence: 99%

“…This helps identify the location of the bilateral phrenic nerves and confirm the location of the superior pole of the thymus while offering a good visualization in the neck area and a safe dissection of thymic veins [42] . Other advantages include minimal postoperative pain with no occurrence of intercostal neuropathy since intercostal spaces are not traversed and cosmetic outcomes are excellent [43,44,48] . In contrast, when comparing the subxiphoid view to the lateral one in the traditional VATS, it becomes difficult to identify the contralateral phrenic nerve, and there is also the risk of intercostal nerve injury, resulting in postoperative chronic incision pain [43,49] .…”

Section: Subxiphoid Thymectomymentioning

confidence: 99%

“…Other advantages include minimal postoperative pain with no occurrence of intercostal neuropathy since intercostal spaces are not traversed and cosmetic outcomes are excellent [43,44,48] . In contrast, when comparing the subxiphoid view to the lateral one in the traditional VATS, it becomes difficult to identify the contralateral phrenic nerve, and there is also the risk of intercostal nerve injury, resulting in postoperative chronic incision pain [43,49] . Zhang et al [43] recently conducted a retrospective analysis comparing 98 patients who underwent a VATS thymectomy through the subxiphoid and subcostal arch approach or the lateral intercostal one.…”

Section: Subxiphoid Thymectomymentioning

confidence: 99%

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Standardized definitions and concepts of radicality during minimally invasive thymoma resection

Iaco¹,

Brascia²,

Geronimo³

et al. 2020

Mini-invasive Surg

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Radical thymectomy is the gold standard treatment for thymoma; in particular, completeness of surgical resection of a well-encapsulated thymoma and adequate margins are considered the most important prognostic factors. According to the International Thymic Malignancy Interest Group instructions, in fact, the thymus should be resected en bloc with its upper cervical poles and the surrounding mediastinal fat and through a no-touch surgical technique. For years, the open approaches have been considered the gold standard treatment for thymic masses, because of technical advantages and proved good oncological results. When applied to properly chosen patients on the basis of the tumor stage, dimension, and histology, minimally invasive approaches could be as effective as open ones in terms of long-term outcomes. To accomplish a minimally invasive thymoma resection, several minimally invasive techniques (transcervical, subxiphoid, thoracoscopic, and robotic) have been described, each presenting advantages and drawbacks. Moreover, when dealing with early stage neoplasms, many authors have proposed to perform the thymomectomy alone, not involving the rest of the thymic gland, but evidence is still imprecise and vague, and some studies have described a higher rate of local recurrence when using this technique. Finally, many studies suggest that surgeons with expertise in minimally invasive lymphadenectomy for lung cancer may easily endorse the idea of nodal dissection, to be performed at least in advanced thymomas involving neighboring structures, large masses, and thymic carcinomas.

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“…Surgery is one of the most effective treatments for patients with myasthenia gravis (MG) [1]. Subxiphoid thoracoscopic thymectomy is less invasive than the lateral approach, so it has been increasingly used in thoracic surgery for cases of MG or anterior mediastinal tumors [2][3][4][5]. Chest tubes have been habitually placed in patients after thoracic surgery to evacuate fluids and air.…”

Section: Introductionmentioning

confidence: 99%

Is chest tube drainage necessary after subxiphoid thoracoscopic thymectomy?

Zhang

et al. 2020

J Cardiothorac Surg

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Background: Subxiphoid thoracoscopic thymectomy has been increasingly performed in recent years. This study aimed to assess the differences in outcomes between subxiphoid thoracoscopic thymectomy with and without chest tube drainage. Methods: Overall, 205 subxiphoid thoracoscopic thymectomy operations were performed for myasthenia gravis, including 90 cases without and 115 cases with chest tube drainage. The clinical characteristics and perioperative outcomes of the patients were compared. Results: The patients included 112 women and 93 men, with a mean age of 41 years. Two patients in the group without and 5 patient in the group with chest tube drainage developed dyspnea. In the group without chest tube, 6 patients had residual pneumothorax or pleural effusion and had a thoracentesis after surgery (6/90). In the group with chest tube, 7 patients developed delayed pleural effusion and had a thoracentesis after chest tube removal (7/ 115). The patients in the group without chest tube drainage group yielded lower pain scores. Conclusions: The omission of chest tube drainage may be a feasible and safe choice for patients with myasthenia gravis undergoing subxiphoid thoracoscopic thymectomy, but further prospective studies are required.

show abstract

Subxiphoid versus lateral intercostal approaches thoracoscopic thymectomy for non-myasthenic early-stage thymoma: A propensity score -matched analysis

Cited by 36 publications

References 18 publications

Video-assisted thoracoscopic surgery is safe and reliable for large and invasive primary mediastinal tumors.

Video-assisted thoracoscopic surgery is safe and reliable for large and invasive primary mediastinal tumors.

Standardized definitions and concepts of radicality during minimally invasive thymoma resection

Is chest tube drainage necessary after subxiphoid thoracoscopic thymectomy?

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