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Liou DZ, Berry MF, Brown LM, Demmy TL, Huang J, Khullar OV, Padda SK, Shah RD, Taylor MD, Toker SA, Weiss E, Wightman SC, Worrell SG, Hayanga JWA. The Society of Thoracic Surgeons Expert Consensus Document on the Surgical Management of Thymomas. Ann Thorac Surg 2024:S0003-4975(24)00338-2. [PMID: 38718878 DOI: 10.1016/j.athoracsur.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
| | - Mark F Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Lisa M Brown
- Division of General Thoracic Surgery, Department of Surgery, UC Davis Health, Sacramento, California
| | - Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Onkar V Khullar
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Sukhmani K Padda
- Department Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Rachit D Shah
- Section of Thoracic and Foregut Surgery, VCU Health System, Richmond, Virginia
| | - Matthew D Taylor
- Division of Thoracic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Seyfi Alper Toker
- Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Elisabeth Weiss
- Department of Radiation Oncology, VCU Health, Richmond, Virginia
| | - Sean C Wightman
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Stephanie G Worrell
- Thoracic Surgery Section, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - J W Awori Hayanga
- Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
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Gan W, Yang MZ, Tan ZH, Xie CL, Sun TY, Yang HX. Robotic portal resection for mediastinal tumours: a prospective observational study. J Cardiothorac Surg 2024; 19:155. [PMID: 38532497 DOI: 10.1186/s13019-024-02660-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/19/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND To demonstrate the effectiveness and feasibility of robotic portal resection (RPR) for mediastinal tumour using a prospectively collected database. METHODS Data from 73 consecutive patients with mediastinal tumours who underwent RPRs were prospectively collected from August 2018 to April 2023. All patients underwent chest and abdominal enhanced computed tomography (CT) and preoperative multidisciplinary team (MDT) discussion. The patients were stratified into two groups based on tumour size: Group A (tumour size < 4 cm) and Group B (tumour size ≥ 4 cm). General clinical characteristics, surgical procedures, and short outcomes were promptly recorded. RESULTS All of the cases were scheduled for RPRs. One patient (1/73, 1.4%) was switched to a small utility incision approach because of extensive pleural adhesion. Two patients (2.8%) converted to sternotomy, however, no perioperative deaths occurred. Most of the tumours were located in the anterior mediastinum (51/73, 69.9%). Thymoma (27/73, 37.0%) and thymic cyst (16/73, 21.9%) were the most common diagnoses. The median diameter of tumours was 3.2 cm (IQR, 2.4-4.5 cm). The median total operative time was 61.0 min (IQR, 50.0-90.0 min). The median intraoperative blood loss was 20 mL (IQR, 5.0-30.0 ml), and only one patient (1.4%) experienced an intraoperative complication. The median length of hospital stay was 3 days (IQR, 2-4 days). Compared with Group A, the median total operative time and console time of Group B were significantly longer (P = 0.006 and P = 0.003, respectively). The volume of drainage on the first postoperative day was greater in group B than in group A (P = 0.013). CONCLUSION RPR is a safe and effective technique for mediastinal tumour treatment, which can expand the application of minimally invasive surgery for the removal of complicated mediastinal tumours.
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Affiliation(s)
- Wei Gan
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou City, Guangdong Province, 510060, P.R. China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
- Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
| | - Mu-Zi Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou City, Guangdong Province, 510060, P.R. China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
- Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
| | - Zi-Hui Tan
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou City, Guangdong Province, 510060, P.R. China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
- Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
| | - Chu-Long Xie
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou City, Guangdong Province, 510060, P.R. China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
- Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
| | - Tian-Yu Sun
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou City, Guangdong Province, 510060, P.R. China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
- Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
| | - Hao-Xian Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou City, Guangdong Province, 510060, P.R. China.
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China.
- Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China.
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Chen H, Xu B, Zhang Q, Chen P, Cai M, Yao J. Anterior mediastinal tumor surgery applying single-port thoracoscopy using the subxiphoid approach. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:239-248. [PMID: 37484634 PMCID: PMC10357856 DOI: 10.5606/tgkdc.dergisi.2023.23455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/29/2022] [Indexed: 07/25/2023]
Abstract
Background This study aims to investigate the effectiveness of application of single-port thoracoscopy using the subxiphoid approach in anterior mediastinal tumor surgery. Methods Between June 2014 and June 2016, a total of 108 patients (59 males, 49 females; mean age: 64.9±7.5 years; range, 45 to 79 years) with anterior mediastinal tumors were randomized into subxiphoid (experimental) or right chest (control) groups. Single-port thoracoscopy using the subxiphoid approach was performed in the subxiphoid group, while thoracoscopy using the right thoracic approach was performed in the control group. Preand postoperative pain stress indicators, Visual Analog Scale scores, quality of life scores, postoperative tumor recurrence, and five-year survival rates were compared between the groups. Results There were no mortality or serious complications in either group. The mean Visual Analog Scale pain scores on postoperative Days 1 and 7 were 6.5±0.8 and 2.9±0.8 in the subxiphoid group, respectively, compared to 7.2±0.8 and 3.4±0.8 in the control group (p<0.05 for all), respectively. The mean quality of life scores on postoperative Days 1 and 7 were 81.5±5.0 and 79.3±7.7, respectively, in the subxiphoid group compared to 72.4±4.3 and 71.3±4.8 in the control group, respectively (p<0.05 for all). Postoperative pain and pain mediator indexes were lower in the subxiphoid group (p<0.05 for all). The postoperative tumor recurrence rates were 3.70% and 20.37% in the subxiphoid and control groups, respectively (p=0.008). The five-year survival rates were 85.2% and 63.0% in the subxiphoid and control groups, respectively (p=0.008). Conclusion Single-port thoracoscopy using the subxiphoid approach is technically feasible, safe, and effective in performing surgery for anterior mediastinal tumors with an intact capsule and a tumor diameter of ≤5 cm.
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Affiliation(s)
- Hao Chen
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Hospital of Putian University, Putian, China
| | - Bindong Xu
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Hospital of Putian University, Putian, China
| | - Qiang Zhang
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Hospital of Putian University, Putian, China
| | - Pengfei Chen
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Hospital of Putian University, Putian, China
| | - Maoen Cai
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Hospital of Putian University, Putian, China
| | - Jinmei Yao
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Hospital of Putian University, Putian, China
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Falkson CB, Vella ET, Ellis PM, Maziak DE, Ung YC, Yu E. Surgical, Radiation, and Systemic Treatments of Patients With Thymic Epithelial Tumors: A Systematic Review. J Thorac Oncol 2023; 18:299-312. [PMID: 36343922 DOI: 10.1016/j.jtho.2022.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/14/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Thymic epithelial tumors are rare and are classified as thymoma, thymic carcinoma, and thymic neuroendocrine tumors. The objective of this systematic review was to evaluate the treatment options for patients with thymic epithelial tumors. METHODS This systematic review was developed by Ontario Health (Cancer Care Ontario)'s Program in Evidence-Based Care and by the Lung Cancer Disease Site Group. MEDLINE, EMBASE, and the Cochrane Library were searched for studies comparing surgical, radiotherapy, or systemic treatments against any combination of these treatments in patients with thymic epithelial tumors. Meta-analyses were conducted with clinically homogenous studies. RESULTS A total of 106 studies were included, mainly from observational studies. There was an overall survival benefit with postoperative radiotherapy for patients with thymic carcinoma (hazard ratio = 0.65, 95% confidence interval: 0.47-0.89) and for patients with thymoma (hazard ratio = 0.70, 95% confidence interval: 0.59-0.82), especially for those with a high risk for mortality. Patients with thymic carcinoma or thymoma had a response to chemotherapy. Selection bias affected the results for studies that evaluated neoadjuvant chemotherapy or minimally invasive surgical techniques. Furthermore, the overall survival benefit found for adjuvant chemotherapy may have been confounded by the administration of postoperative radiotherapy. CONCLUSIONS For patients with thymoma or thymic carcinoma, the literature is of low quality and subject to bias. There were overall survival benefits with postoperative radiotherapy. The results of this systematic review were used to inform treatment recommendations in a clinical practice guideline. Future large-scale prospective studies that control for confounders are needed.
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Affiliation(s)
- Conrad B Falkson
- Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston General Hospital and Queen's University, Kingston, Ontario, Canada
| | - Emily T Vella
- Program in Evidence-Based Care, McMaster University, Hamilton, Ontario, Canada.
| | - Peter M Ellis
- Medical Oncology, Juravinski Cancer Centre and Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Donna E Maziak
- Thoracic Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Yee C Ung
- Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Edward Yu
- Radiation Oncology, London Regional Cancer Centre and Western University, London, Ontario, Canada
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Wang CQ, Wang J, Liu FY, Wang W. Robot-assisted thoracoscopic surgery vs. sternotomy for thymectomy: A systematic review and meta-analysis. Front Surg 2023; 9:1048547. [PMID: 36684131 PMCID: PMC9852331 DOI: 10.3389/fsurg.2022.1048547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/25/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction Surgeons have widely regarded sternotomy (ST) as the standard surgical method for thymectomy. Minimally invasive methods for thymectomy, including video-assisted and robot-assisted thoracoscopic surgery (RATS), have been explored. There are some studies have researched and compared the outcomes of patients after robotic and sternotomy procedure. Methods We searched the databases of Pubmed, the Cochrane Library, Embase and selected the studies on the efficacy and safety of RATS or ST for thymectomy. Meta-analysis was performed for operation time, operation blood loss, postoperative drainage time, operative complications and hospitalization time. Results A total of 16 cohort studies with 1,089 patients were included. Compared to ST, RATS is an appropriate alternative for thymectomy which reduced operation blood loss [standardized mean difference (SMD) = -1.82, 95% confidence interval (95% CI): (-2.64, -0.99), p = 0.000], postoperative drainage time [SMD = -2.47, 95% Cl: (-3.45, -1.48), p = 0.000], operative complications [odds ratio (OR) = 0.31, 95% Cl: (0.18, 0.51), p = 0.000] and hospitalization time [SMD = -1.62, 95% Cl: (-2.16, -1.07), p = 0.000]. Conclusions This meta-analysis based on cohort studies shows that RATS has more advantages over ST. Therefore, RATS is a more advanced and suitable surgical method for thymectomy.
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Affiliation(s)
- Cheng-qian Wang
- Department of Thoracic Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China,The Second Medical College, Binzhou Medical University, Yantai, China
| | - Jie Wang
- The Second Medical College, Binzhou Medical University, Yantai, China
| | - Fei-yu Liu
- Department of Pharmacy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Wei Wang
- Department of Thoracic Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China,Correspondence: Wei Wang
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Soder SA, Pollock C, Ferraro P, Lafontaine E, Martin J, Nasir B, Liberman M. Post-Operative Outcomes Associated With Open Versus Robotic Thymectomy: A Propensity Matched Analysis. Semin Thorac Cardiovasc Surg 2023; 35:189-199. [PMID: 34838953 DOI: 10.1053/j.semtcvs.2021.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 12/23/2022]
Abstract
To compare post-operative outcomes associated with thymectomy performed using either open or robotic approaches. Retrospective cohort study from a single-center prospective registry consisting of patients undergoing thymectomy between 2000 and 2020. Patients were grouped according to surgical approach (open vs robotic). A propensity-score matching analysis was performed in a 2:1 open to robotic ratio, and surgical outcomes were evaluated. We analyzed 234 thymectomies (155 open; 79 robotic). Myasthenia gravis was present in 23.2% and 32.9% (P = 0.249) in the open and in the robotic group, respectively. All covariates were balanced in the matched groups (open n = 114; robotic n =5 9), except lesion size. The robotic approach was significantly associated with shorter surgical time (median 95 vs 65 minutes, P < 0.001), lesser clinical (21.1% vs 6.8%, P = 0.016) and surgical (11.4% vs 1.7%, P = 0.036) complications during the same hospitalization, less Clavien-Dindo grade 2 or higher complication rates (28.1 vs 15.3%, P = 0.048), chest tube duration (median: 3 vs 0 days, P < 0.001) and in-hospital length of stay (median: 5 vs 0 days, P < 0.001). Bleeding (P = 0.214), ICU length of stay (P = 0.167), reoperation rate (open, 1.8% vs robotic 0%), 90-day mortality (P = 0.341) and readmission rate post discharge (P = 0.277) were similar between the groups. In the matched population with primary thymic epithelial tumors, the completeness of resection rate was similar (open, 92.1% vs robotic 96.8%, P = 0.66.). Robotic thymectomy is associated with improved post-operative outcomes when compared to open thymectomy, without compromising the goals of oncologic surgery. Longer follow-up is needed to ensure oncologic equivalence.
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Affiliation(s)
- Stephan A Soder
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada
| | - Clare Pollock
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada
| | - Pasquale Ferraro
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada
| | - Edwin Lafontaine
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada
| | - Jocelyne Martin
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada
| | - Basil Nasir
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada
| | - Moishe Liberman
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada..
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Jiang B, Tan Q, Deng B, Mei L, Lin Y, Zhu L. Robot-assisted thymectomy in large anterior mediastinal tumors: A comparative study with video-assisted thymectomy and open surgery. Thorac Cancer 2022; 14:267-273. [PMID: 36433677 PMCID: PMC9870738 DOI: 10.1111/1759-7714.14744] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the safety and effectiveness of robot-assisted thymectomy (RAT) in large anterior mediastinal tumors (AMTs) (size ≥6 cm) compared with video-assisted thymectomy (VAT) and open surgery. METHODS A total of 132 patients with large AMTs who underwent surgical resection from January 2016 to June 2022 were included in this study. A total of 61 patients underwent RAT, 36 patients underwent VAT and 35 patients underwent open surgery. Perioperative outcomes were compared. RESULTS There were no significant differences in tumor size (p = 0.141), or pathological types (p = 0.903). Compared with the open group, the RAT and VAT groups were associated with a shorter operation time (115.00 vs. 160.00, p = 0.012; 122.50 vs. 160.00, p = 0.071), and less blood loss (50.00 vs. 200.00, p < 0.001; 50.00 vs. 200.00, p < 0.001), respectively. The rate of conversion in the RAT group was similar to that in the VAT group (6.56% vs. 13.89%, p = 0.229). Concomitant resection was less frequently performed in the VAT group than in the RAT and open groups (5.56% vs. 31.15%, p = 0.040; 5.56% vs. 31.43%, p = 0.006). VAT patients had a lower drainage volume (365.00 vs. 700.00 and 910.00 mL, p < 0.001), shorter duration of chest tube (2.00 vs. 3.00 and 4.00, p < 0.001), and shorter hospital stay (5.00 vs. 6.00 and 7.00, p < 0.001) than the RAT and open groups. There was no 30-day mortality in any group. No difference was seen in R0 resection rates (p = 0.846). The postoperative complication rates were similar among the three groups (p = 0.309). Total in-hospital costs (66493.90 vs. 33581.05 and 42876.40, p < 0.001) were significantly higher in the RAT group. CONCLUSIONS RAT is safe and effective for the resection of large AMTs compared to VAT and open surgery. Vascular resection in RAT is technically feasible. A long-term follow-up is required.
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Affiliation(s)
- Bin Jiang
- Department of Thoracic SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Qun‐You Tan
- Department of Thoracic Surgery, Daping Hospital (Army Medical Center of Chinese People's Liberation Army)Army Medical UniversityChongqingChina
| | - Bo Deng
- Department of Thoracic Surgery, Daping Hospital (Army Medical Center of Chinese People's Liberation Army)Army Medical UniversityChongqingChina
| | - Long‐Yong Mei
- Department of Thoracic Surgery, Daping Hospital (Army Medical Center of Chinese People's Liberation Army)Army Medical UniversityChongqingChina
| | - Yi‐Dan Lin
- Department of Thoracic SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Long‐Fei Zhu
- Department of Thoracic Surgery, Daping Hospital (Army Medical Center of Chinese People's Liberation Army)Army Medical UniversityChongqingChina
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Park S. Robot-Assisted Thoracic Surgery Thymectomy. J Chest Surg 2021; 54:319-324. [PMID: 34353974 PMCID: PMC8350461 DOI: 10.5090/jcs.21.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022] Open
Abstract
Robotic thymectomy has been adopted recently and has been shown to be safe and feasible in treating thymic tumors and myasthenia gravis. The surgical indications of robotic technology are expanding, with advantages including an excellent surgical view and sophisticated manipulation. Herein, we describe technical aspects, considerations, and outcomes of robotic thymectomy.
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Affiliation(s)
- Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Nakagawa K, Asamura H. Limited resection for early-stage thymoma: minimally invasive resection does not mean limited resection. Jpn J Clin Oncol 2021; 51:1197-1203. [PMID: 34212196 DOI: 10.1093/jjco/hyab102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/16/2021] [Indexed: 11/15/2022] Open
Abstract
Standard resection for patients with thymoma is resection of thymoma with total thymectomy (TTx) via median sternotomy. Hence, limited resection for thymoma means a lesser extent of resection of normal thymus compared with a standard procedure, i.e. resection of thymoma with partial thymectomy (PTx). In contrast, minimally invasive resection has been defined as resection of thymoma with TTx via a less-invasive approach. However, to date, few studies have precisely evaluated the differences in surgical and oncological outcomes among these three procedures. This report summarizes the differences among these three procedures with a review of studies (January 2000 to December 2020) focusing on the difference in surgical and oncological outcomes and presents current issues in the surgical management of thymoma. In this report, 16 studies were identified; 5 compared standard resection to limited resection, 9 compared standard resection to minimally invasive resection and 2 compared limited resection to minimally invasive resection. Most studies reported that the surgical and oncological outcomes of limited resection or minimally invasive resection were similar to those of standard resection in patients with early-stage thymoma. However, they did not include a sufficient follow-up period. Both limited resection and minimally invasive resection for early-stage thymoma might be reasonable treatment options. However, they are still promising modes of resection. Further studies with a long follow-up period are needed.
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Affiliation(s)
- Kazuo Nakagawa
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
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Ancin B, Melih Ozercan M, Yilmaz Y, Uysal S, Kumbasar U, Dikmen E, Yilmaz M, Dogan R. Comparison of Early Postoperative Outcomes of Patients Undergoing Robot-Assisted and Transsternal Thymectomy. JOURNAL OF MEDICAL AND SURGICAL RESEARCH 2021. [DOI: 10.46327/msrjg.1.000000000000199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: Robot-assisted thoracoscopic surgery (RATS) is a minimally invasive technique that has been used in thymectomy operations in recent years. Minimally invasive surgical techniques offer less postoperative pain, a shorter length of hospital stay, and faster recovery compared to conventional surgical techniques. In our study, we aimed to compare the outcomes of robotic and transsternal thymectomies by analyzing the operative and postoperative data of these two approaches. Methods: Twelve robotic thymectomy patients and 16 transsternal thymectomy patients who were operated on in our clinic in 2018 were included in the study. Results: There was no significant difference between the two groups in terms of operative time (p=0.231). The median chest tube duration was 1.5 [range, 1-2] days in robotic thymectomy and 2.5 [range, 1-3.75] days in transsternal thymectomy. However, there was no statistically significant difference between the two groups (p=0.082). The amount of chest tube drainage was significantly lower in the robotic thymectomy group (p=0.006). The length of hospital stay was also significantly shorter in robotic thymectomy patients (p<0.001). Conclusion: The amount of chest tube drainage was lower and the length of hospital stay was shorter in the robotic surgery compared to the transsternal approach. There was no significant difference between the two techniques in terms of operative time. Within today's minimally invasive surgical techniques, robotic thymectomy can be considered a practical, comfortable, and safe technique with better early postoperative outcomes.
Keywords: Robot-Assisted Thymectomy, Thymectomy, Transsternal Thymectomy
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Geraci TC, Ferrari-Light D, Pozzi N, Cerfolio RJ. Midterm Results for Robotic Thymectomy for Malignant Disease. Ann Thorac Surg 2020; 111:1675-1681. [PMID: 32926846 DOI: 10.1016/j.athoracsur.2020.06.111] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/28/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are limited reports on robotic thymectomy for malignant disease. Our objectives are to review our experience and midterm outcomes. METHODS We reviewed a single-surgeon prospective database for patients who underwent planned robotic resection for malignancy from January 2010 to June 2019. RESULTS Two hundred thirteen patients underwent resection of an anterior mediastinal mass, all of which were planned for a robotic approach. Of these, 84 (39%) underwent robotic thymectomy for malignant disease. Thymoma was the most common pathology resected (68%). Median tumor size was 4.7 cm (interquartile range, 2.9-6.3), and median operative time was 81.5 minutes (interquartile range, 64-104). All except 1 patient had a complete (R0) resection (98.8%). There were 2 (2.3%) unplanned but elective conversions to open surgery, 1 of which required cardiopulmonary bypass. Median length of stay was 1 day (range, 0-9) with 1 readmission (1.2%). Major morbidity occurred in 3 patients (3.5%), and there were no 30- or 90-day mortalities. In patients with thymoma, follow-up was complete at a median of 32 months (range, 1-98), and 1 patient (1.8%) had an ipsilateral chest recurrence. To date there have been no patient deaths. CONCLUSIONS Robotic thymectomy for patients with malignant disease is safe with excellent perioperative outcomes. A robotic approach achieves a high rate of complete R0 resection, even for larger tumors. For patients with thymoma local recurrence is low after midterm follow-up, but longer-term analysis is needed to determine oncologic durability.
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Affiliation(s)
- Travis C Geraci
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York.
| | | | - Natalie Pozzi
- Department of Surgery, Saint Mary's Hospital, Waterbury, Connecticut
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
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Li J, Qi G, Liu Y, Zheng X, Zhang X. Meta-analysis of subxiphoid approach versus lateral approach for thoracoscopic Thymectomy. J Cardiothorac Surg 2020; 15:89. [PMID: 32398115 PMCID: PMC7216611 DOI: 10.1186/s13019-020-01135-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/04/2020] [Indexed: 11/22/2022] Open
Abstract
Background Compared with traditional open surgery for thymectomy, video-assisted thoracoscopic surgery (VATS) reduces hospital stay, decreases postoperative pain, and recovers faster. VATS has become increasingly popular in the past decade. VATS techniques to perform a thymectomy include subxiphoid video-assisted thoracoscopic surgery (SVATS) or lateral video-assisted thoracoscopic surgery (LVATS). In this study, our objective was to systematically review on VATS thymectomy and draw a meta-analysis on the outcomes between the two approaches. Methods We searched online databases and identified studies from database inception to 2019 that compared SVATS to LVATS thymectomy. Study endpoints included operative time, operative blood loss, length of hospital stay, postoperative pleural drainage, postoperative complications, conversion to open, oncologic outcomes. Results Four hundred seventy-one patients were included in this study, for which 200 and 271 patients underwent SVATS and LVATS thymectomy, respectively. Patients in the SVATS group had significantly less operative time, operative blood loss, length of hospital stay, and postoperative complications were identified. There was no statistical difference in postoperative pleural drainage, conversion to open and oncologic outcomes. No hospital deaths were recorded for either procedure. Conclusions While randomized controlled studies are required to make definitive conclusions, this meta-analysis suggests that SVATS thymectomy is safe and can achieve good and safe operative and perioperative outcomes similar or better to LVATS thymectomy.
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Affiliation(s)
- Jiaduo Li
- Center of Treatment of Myasthenia Gravis Hebei Province, First Hospital of Shijiazhuang, Fangbei road No. 9, Shijiazhuang, 050011, Hebei Province, China
| | - Guoyan Qi
- Center of Treatment of Myasthenia Gravis Hebei Province, First Hospital of Shijiazhuang, Fangbei road No. 9, Shijiazhuang, 050011, Hebei Province, China.
| | - Yaling Liu
- Department of Gastroenterology, First Hospital of Shijiazhuang, Shijiazhuang, China
| | - Xuguang Zheng
- Center of Treatment of Myasthenia Gravis Hebei Province, First Hospital of Shijiazhuang, Fangbei road No. 9, Shijiazhuang, 050011, Hebei Province, China
| | - Xiaohe Zhang
- Center of Treatment of Myasthenia Gravis Hebei Province, First Hospital of Shijiazhuang, Fangbei road No. 9, Shijiazhuang, 050011, Hebei Province, China
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13
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Hess NR, Baker N, Levy RM, Pennathur A, Christie NA, Luketich JD, Sarkaria IS. Robotic assisted minimally invasive thymectomy with simultaneous bilateral thoracoscopy and contralateral phrenic nerve visualization. J Thorac Dis 2020; 12:114-122. [PMID: 32190361 DOI: 10.21037/jtd.2020.01.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Thoracoscopic approaches to thymectomy and anterior mediastinal mass resection has become increasingly common due to the potential for decreased blood loss and hospital length of stay. However, contralateral mediastinal and phrenic nerve visualization if often difficult from these unilateral approaches, which may affect the ability to achieve a full phrenic to phrenic dissection Herein, we present our early experience of robotic assisted minimally invasive thymectomy (RAMIT) with simultaneous bilateral thoracoscopy and contralateral phrenic nerve visualization. Methods This was a retrospective review of all sequential patients undergoing RAMIT with simultaneous bilateral thoracoscopy from January 2015 to May 2016. This study was approved by our Institutional Review Board (PRO15080367). Individual patient consent was waived. Results Twenty-six patients [median age 58 (range, 29-76) years] were included in this study. Sixteen operations were performed for anterior mediastinal mass, 7 for non-thymomatous myasthenia gravis, and 3 for concurrent myasthenia gravis and thymoma. Median blood loss and hospital stay were 25 mL (range, 3-150 mL) and 3 days (range, 2-8 days), respectively. Twenty-one (80.8%) patients experienced an uncomplicated hospital course. The highest graded complication by Clavien Dindo Classification was a grade III due to pleural effusion requiring drainage via pleural catheter. One patient experienced asymptomatic hemidiaphram palsy postoperatively. There were no 90-day postoperative deaths. Conclusions RAMIT with simultaneous bilateral thoracoscopy is a feasible approach that may allow for enhanced visualization and more complete thymic resection compared to existing unilateral minimally invasive operations. Comparative studies and long-term follow up are needed to adequately assess the potential benefits of RAMIT.
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Affiliation(s)
- Nicholas R Hess
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nicholas Baker
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ryan M Levy
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arjun Pennathur
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Neil A Christie
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Inderpal S Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Şehitogullari A, Nasır A, Anbar R, Erdem K, Bilgin C. Comparison of perioperative outcomes of videothoracoscopy and robotic surgical techniques in thymoma. Asian J Surg 2020; 43:244-250. [DOI: 10.1016/j.asjsur.2019.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/06/2019] [Accepted: 04/09/2019] [Indexed: 10/26/2022] Open
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Yang CFJ, Hurd J, Shah SA, Liou D, Wang H, Backhus LM, Lui NS, D'Amico TA, Shrager JB, Berry MF. A national analysis of open versus minimally invasive thymectomy for stage I to III thymoma. J Thorac Cardiovasc Surg 2019; 160:555-567.e15. [PMID: 32245668 DOI: 10.1016/j.jtcvs.2019.11.114] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 11/16/2019] [Accepted: 11/19/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The oncologic efficacy of minimally invasive thymectomy for thymoma is not well characterized. We compared short-term outcomes and overall survival between open and minimally invasive (video-assisted thoracoscopic and robotic) approaches using the National Cancer Data Base. METHODS Perioperative outcomes and survival of patients who underwent open versus minimally invasive thymectomy for clinical stage I to III thymoma from 2010 to 2014 in the National Cancer Data Base were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis. Predictors of minimally invasive use were evaluated using multivariable logistic regression. Outcomes of surgical approach were evaluated using an intent-to-treat analysis. RESULTS Of the 1223 thymectomies that were evaluated, 317 (26%) were performed minimally invasively (141 video-assisted thoracoscopic and 176 robotic). The minimally invasive group had a shorter median length of stay when compared with the open group (3 [2-4] days vs 4 [3-6] days, P < .001). In a propensity score-matched analysis of 185 open and 185 minimally invasive (video-assisted thoracoscopic + robotic) thymectomy, the minimally invasive group continued to have a shorter median length of stay (3 vs 4 days, P < .01) but did not have significant differences in margin positivity (P = .84), 30-day readmission (P = .28), 30-day mortality (P = .60), and 5-year survival (89.4% vs 81.6%, P = .20) when compared with the open group. CONCLUSIONS In this national analysis, minimally invasive thymectomy was associated with shorter length of stay and was not associated with increased margin positivity, perioperative mortality, 30-day readmission rate, or reduced overall survival when compared with open thymectomy.
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Affiliation(s)
| | - Jacob Hurd
- Duke University Medical Center, Durham, NC
| | | | | | | | - Leah M Backhus
- Stanford University, Stanford, Calif; VA Palo Alto Health Care System, Palo Alto, Calif
| | | | | | | | - Mark F Berry
- Stanford University, Stanford, Calif; VA Palo Alto Health Care System, Palo Alto, Calif.
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Tianci C, Shen Z, Chen S, Lin Y, Gao L, Zhang Z, Kang M, Lin J. Median sternotomy versus minimally invasive thymectomy for early-stage thymoma: A systematic review and meta-analysis protocol. Medicine (Baltimore) 2019; 98:e18359. [PMID: 31860993 PMCID: PMC6940122 DOI: 10.1097/md.0000000000018359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The completeness of resection is an important prognostic factor for early resectable thymoma. Since its inception 2 decades ago, median sternotomy has been recognized as the gold standard method for the treatment of all types and stages of thyomas. Minimally invasive surgical techniques, including video-assisted and robot-assisted surgery, have been rapidly developed as an alternative to traditional open approach surgery. Compared with traditional open approach surgery, minimally invasive approach has better cosmetic effect, faster improvement of lung function, reduction of surgical trauma, length of stay, and complications. We believe that this is an appropriate time and there is a need for a systematic, comprehensive, and objective assessment of the 2 surgical modalities in order to provide reliable evidence for clinicians to determine the best treatment for patients with early resectable thymoma. METHODS Pubmed (Medline), Web of Science, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar will be searched for relevant randomized controlled trials (RCTs), quasi-RCTs, and Hi-Q (high quality) prospective cohort trials published or unpublished in any language before March 1, 2020. Subgroup analysis will be performed in tumor pathological stage and ethnicity. PROSPERO registration number: CRD42019133724. RESULTS The results of this study will be published in a peer-reviewed journal. CONCLUSION This study will be the first to assess the efficacy and safety of median sternotomy recognized as the gold standard method for the treatment of all types and stages of thyomas and minimally invasive thymectomy for patients with early-stage thymoma. This study will assess whether minimally invasive thoracoscopic and robotic assisted thymectomy can be used as an alternative to traditional median sternotomy for patients with early resectable thymoma and provide high-quality and reliable evidence for clinicians' decision-making.
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Affiliation(s)
- Chai Tianci
- Department of Thoracic Surgery, Fujian Medical University Union Hospital
| | - Zhimin Shen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital
| | - Sui Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital
| | - Yuhan Lin
- School of Stomatology, Fujian Medical University, Fuzhou, China
| | - Lei Gao
- Department of Thoracic Surgery, Fujian Medical University Union Hospital
| | - Zhenyang Zhang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital
| | - Mingqiang Kang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital
| | - Jiangbo Lin
- Department of Thoracic Surgery, Fujian Medical University Union Hospital
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Marulli G, Comacchio GM, Schiavon M, Rebusso A, Mammana M, Zampieri D, Perissinotto E, Rea F. Comparing robotic and trans-sternal thymectomy for early-stage thymoma: a propensity score-matching study. Eur J Cardiothorac Surg 2019; 54:579-584. [PMID: 29547970 DOI: 10.1093/ejcts/ezy075] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 02/02/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Minimally invasive techniques seem to be promising alternatives to open approaches in the surgical treatment of early-stage thymoma, although there are controversies because of lack of data on long-term results. The aim of the study was to evaluate the surgical and oncological results after robotic thymectomy for early-stage thymoma compared to median sternotomy. METHODS Between 1982 and 2017, 164 patients with early-stage thymoma (Masaoka I and II) were operated on by median sternotomy (108 patients) or the robotic approach (56 patients). Duration of surgery, amount of blood loss, complications, duration of chest drainage, postoperative hospital stay, oncological results and total costs were retrospectively evaluated. Data were analysed also after propensity score matching. RESULTS Compared to the trans-sternal group, robotic thymectomy had significantly longer average operative times (P < 0.001) but less intraoperative blood loss (P = 0.01), less perioperative complications (P = 0.03), shorter time to chest drainage removal and hospital discharge (P < 0.001). The median expense for the trans-sternal approach was significantly higher than the cost of the robotic procedure (P < 0.001), mainly due to longer hospitalization. From an oncological point of view, there were no differences in thymoma recurrence, although follow-up of the trans-sternal group was significantly longer (P < 0.001). Data were confirmed after propensity score matching. CONCLUSIONS 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.
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Affiliation(s)
- Giuseppe Marulli
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy
| | - Giovanni Maria Comacchio
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy
| | - Alessandro Rebusso
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy
| | - Davide Zampieri
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy
| | - Egle Perissinotto
- Biostatistic Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy
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Comacchio GM, Marulli G, Mammana M, Natale G, Schiavon M, Rea F. Surgical Decision Making. Thorac Surg Clin 2019; 29:203-213. [DOI: 10.1016/j.thorsurg.2018.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
- Amelia Evoli
- Institute of Neurology, Università Cattolica del Sacro Cuore, Roma, Italy
- Fondazione Policlinico Gemelli, IRCCS, Roma, Italy
| | - Elisa Meacci
- Fondazione Policlinico Gemelli, IRCCS, Roma, Italy
- Institute of Thoracic Surgery, Università Cattolica del Sacro Cuore, Roma, Italy
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20
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O'Sullivan KE, Kreaden US, Hebert AE, Eaton D, Redmond KC. A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy. Ann Cardiothorac Surg 2019; 8:174-193. [PMID: 31032201 DOI: 10.21037/acs.2019.02.04] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Median sternotomy has been the most commonly used approach for thymectomy to date. Recent advances in video-assisted thoracoscopic surgery (VATS) and robotic access with CO2 insufflation techniques have allowed more minimally invasive approaches. However, prior reviews have not compared robotic to both open and VATS thymectomy. Methods A systematic review was conducted in accordance with the PRISMA guidelines using PubMed, Embase and Scopus databases. Original research articles comparing robotic to VATS or to open thymectomy for myasthenia gravis, anterior mediastinal masses, or thymomas were included. Meta-analyses were performed for mortality, operative time, blood loss, transfusions, length of stay, conversion to open, intraoperative and postoperative complication rates, and positive/negative margin rates. Results Robotic thymectomy is a valid alternative to the open approach; advantages include: reduced blood loss [weighted mean difference (WMD): -173.03, 95% confidence interval (95% CI): -305.90, -40.17, P=0.01], fewer postoperative complications (odds ratio: 0.37, 95% CI: 0.22, 0.60, P<0.00001), a shorter hospital stay (WMD: -2.78, 95% CI: -3.22, -2.33, P<0.00001), and a lower positive margin rate (relative difference: -0.04, 95% CI: -0.07, -0.01, P=0.01), with comparable operative times (WMD: 6.73, 95% CI: -21.20, 34.66, P=0.64). Robotic thymectomy was comparable with the VATS approach; both have the advantage of avoiding median sternotomy. Conclusions While randomized controlled studies are required to make definitive conclusions, current data suggests that robotic thymectomy is superior to open surgery and comparable to a VATS approach. Long-term follow-up is required to further delineate oncological outcomes.
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Affiliation(s)
- Katie E O'Sullivan
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Eccles St., Dublin, Ireland
| | - Usha S Kreaden
- Clinical Affairs, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - April E Hebert
- Clinical Affairs, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - Donna Eaton
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Eccles St., Dublin, Ireland
| | - Karen C Redmond
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Eccles St., Dublin, Ireland
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21
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Amore D, Scaramuzzi R, Di Natale D, Curcio C. Hemorrhagic complication during robotic surgery in patient with thymomatous myasthenia gravis. J Vis Surg 2018; 4:41. [PMID: 29552523 DOI: 10.21037/jovs.2018.01.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 11/06/2022]
Abstract
The advantages of thymectomy as part of the treatment of myasthenia gravis has been demonstrated repeatedly in the literature. Both single-institution and multi-institution trials have shown robotic thymectomy to be safe, feasible and associated with better early clinical outcomes than the trans-sternal approach. Most reports have also documented the superiority of robotic technology in the dissection of the superior mediastinum over conventional thoracoscopy, thanks to instruments with more degrees of movement and freedom. However, in case of a vascular injury in the superior mediastinum, after an initial management with minimally invasive approach, one should not hesitate to convert to sternotomy if the bleeding control hasn't been definitely established. In this way it is possible to avoid catastrophic injuries, also in relation to the limitations that, in our opinion, the robotic surgery has once a major vascular injury occurs in the mediastinum.
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Affiliation(s)
- Dario Amore
- Division of Thoracic Surgery, Monaldi Hospital, Naples, Italy
| | | | | | - Carlo Curcio
- Division of Thoracic Surgery, Monaldi Hospital, Naples, Italy
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Robotic Thymectomy Is Feasible for Large Thymomas: A Propensity-Matched Comparison. Ann Thorac Surg 2017; 104:1673-1678. [PMID: 28935345 DOI: 10.1016/j.athoracsur.2017.05.074] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/18/2017] [Accepted: 05/22/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Robotic-assisted thymectomy (RAT) is increasingly performed for resection of thymomas. Its application for large tumors remains controversial. In this study, we evaluated the safety and feasibility of RAT for large thymomas in comparison with transsternal thymectomy (ST). METHODS A single institution database was reviewed for patients who underwent RAT for thymoma of 4 cm or larger between 2004 and 2016. Propensity scores were applied to match RAT with ST patients, based on age, sex, tumor size, and Masaoka stage. Perioperative outcomes were compared. RESULTS Twenty patients (15 women and 5 men, median age 59 years) underwent RAT for a large thymoma (median size 6.0 cm). A right-sided approach was used in 14 patients (70%). A control group of 34 ST patients (median size 6.7 cm) had similar Masaoka staging (p = 0.64). Combined resection of adjacent structures, including pericardium, lung, and phrenic nerve, were frequently performed in both groups (50% RAT versus 47% ST, p = 0.83). RAT patients had lower blood loss (25 mL versus 150 mL, p = 0.001), were more frequently managed with a single chest tube (85% versus 56%, p = 0.027), and had a shorter median length of stay (3 days versus 4 days, p = 0.034). There were no perioperative deaths and no major vascular injuries. Three RAT patients (15%) were converted to open approach. Overall complication rates were similar between RAT and ST patients (15% versus 24%, p = 0.45). No difference was seen in R0 resection rates (90% versus 85%, p = 0.62). CONCLUSIONS RAT can be performed safely and effectively in a radical fashion for large thymomas. Future studies are necessary to determine long-term oncologic outcomes.
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Gkouma A. Robotically assisted thymectomy: a review of the literature. J Robot Surg 2017; 12:3-10. [PMID: 28905304 DOI: 10.1007/s11701-017-0748-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 09/04/2017] [Indexed: 11/26/2022]
Abstract
The aim of this literature review is to see where the robotic thymectomy stands nowadays. A thorough search of the PubMed revealed eighty-two related articles which reviewed comprehensively. The zero intraoperative mortality, the minimal intraoperative morbidity, as well as the recorded recurrence rate of 0-11.1% and complete stable remission rate of 0-40% suggests that the robotic-assisted thymectomy is a feasible, safe and an upcoming procedure. However, the lack of prospective randomized controlled trials prevents this technique to become the standard approach for the nonce.
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Affiliation(s)
- Antonia Gkouma
- Cardiothoracic Surgery Department, St. Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
- 251 General Airforce Hospital, Panagioti Kanellopoulou 3, Athens, 11525, Greece.
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Kuo SW, Huang PM, Lin MW, Chen KC, Lee JM. Robot-assisted thoracic surgery for complex procedures. J Thorac Dis 2017; 9:3105-3113. [PMID: 29221285 DOI: 10.21037/jtd.2017.08.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background As an option for minimally invasive thoracic surgery, robot-assisted thoracic surgery (RATS) has shown comparable perioperative outcomes to those achieved by traditional video-assisted thoracic surgery (VATS). It is unknown whether RATS might have any potential benefits in more complex thoracic surgical procedures, which usually require open surgery instead of VATS. The current study presents a preliminary result regarding the use of RATS in complex thoracic operations in an attempt to address this unresolved question. Methods Data from a prospectively collected and maintained surgical database were collected on patients who underwent RATS between February 2012 and August 2014. We defined complex RATS as those operations involving difficult dissections, complex sutures or excision of very large tumors (>8 cm) which would have required open surgery in our hospital before the introduction of RATS. The characteristics and peri-operative outcomes of patients receiving complex RATS were reviewed. Results Of the 120 patients undergoing RATS, 30 of them were classified as having undergone complex RATS, 21 to remove lung tumors and 9 to remove mediastinal tumors. The indications for complex RATS included 21 difficult dissections, 10 complex sutures, and 7 very large tumors (8 patients had two indications). There are three conversions to thoracotomy for pulmonary arterial bleeding. There was one mortality resulted from post-pneumonectomy pulmonary hypertension and sepsis. Patients with difficult dissection had longer operative time and hospital stay, and more bleeding and postoperative morbidity. Conclusions RATS for complex thoracic procedures is feasible, especially for complex suturing and excision of very large mediastinal tumors, but more attention is needed for patients needing difficult dissections. Advanced preparation for conversion is necessary during this difficult operation.
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Affiliation(s)
- Shuenn-Wen Kuo
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Ming Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ke-Cheng Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jang-Ming Lee
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Buentzel J, Straube C, Heinz J, Roever C, Beham A, Emmert A, Hinterthaner M, Danner BC, Emmert A. Thymectomy via open surgery or robotic video assisted thoracic surgery: Can a recommendation already be made? Medicine (Baltimore) 2017; 96:e7161. [PMID: 28614249 PMCID: PMC5478334 DOI: 10.1097/md.0000000000007161] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Robot-assisted minimally invasive surgery (RVATS) is a relatively new technique applied for thymectomies. Only few studies directly compare RVATS to the mainstay therapy, open surgery (sternotomy). METHODS A systematic search of the literature was performed in October 2016. The meta-analysis includes studies comparing robotassisted and open thymectomy regarding operation time, length of hospitalization, intraoperative blood loss, and chest-in-tube days, postoperative complications, reoperation, arrhythmic events, pleural effusion, and postoperative bleeding. RESULTS Of 626 studies preliminary screened, 7 articles were included. There were no significant differences in comparison of operation time (-3.19 minutes [95% confidence interval, 95% CI -112.43 to 106.05]; P = .94), but patients undergoing RVATS spent significantly less time in hospital (-4.06 days [95% CI -7.98 to -0.13], P = .046). There were fewer chests-in-tube days (-2.50 days [95% CI -15.01 to 10.01]; P = .24) and less intraoperative blood loss (-256.84 mL [95% CI -627.47 to 113.80]; P = .10) observed in the RVATS group; due to a small number of studies, these results were not statistically significant. There were also less post-operative complications in the RVATS group (12 complications in 209 patients vs 51 complications in 259 patients); however, this difference was not statistical significant (odds ratio 0.27, 95% CI 0.07-1.12; P = .06). CONCLUSIONS Patients undergoing RVATS spent less time in hospital than patients treated by open surgery (sternotomy). These patients tended to have less postoperative complications, less intraoperative blood loss, and fewer chest-in-tube days. We found evidence for the safety and feasibility of RVATS compared with open surgery, which has to be further confirmed in randomised controlled trials.
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Affiliation(s)
| | | | | | | | - Alexander Beham
- Department of General, Visceral and Pediatric Surgery, University of Goettingen, University Medical Center Goettingen, Goettingen
| | - Andreas Emmert
- Westklinikum Hamburg, Department of General and Visceral Surgery, Hamburg
| | - Marc Hinterthaner
- Department of Thoracic and Cardiovascular Surgery, University of Goettingen, University Medical Center Goettingen, Göttingen, Germany
| | - Bernhard C. Danner
- Department of Thoracic and Cardiovascular Surgery, University of Goettingen, University Medical Center Goettingen, Göttingen, Germany
| | - Alexander Emmert
- Department of Thoracic and Cardiovascular Surgery, University of Goettingen, University Medical Center Goettingen, Göttingen, Germany
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Robotic Resection of 3 cm and Larger Thymomas Is Associated With Low Perioperative Morbidity and Mortality. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 11:321-326. [PMID: 27631952 DOI: 10.1097/imi.0000000000000295] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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 1 day); P = 0.024. The median hospital stay was shorter for robotic (2 days) versus open (5 days); P < 0.001. CONCLUSIONS 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, oncologic outcomes are immature and require prolonged surveillance.
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Odaka M, Tsukamoto Y, Shibasaki T, Mori S, Asano H, Yamashita M, Morikawa T. Surgical and oncological outcomes of thoracoscopic thymectomy for thymoma. J Vis Surg 2017; 3:54. [PMID: 29078617 DOI: 10.21037/jovs.2017.03.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 01/16/2017] [Indexed: 11/06/2022]
Abstract
Thymoma remains the most common primary anterior mediastinal neoplasm. Surgical resection remains central to the treatment of thymoma, with thoracoscopic thymectomy (TT) being increasingly performed. This present review article aimed to summarize current studies comparing TT and open thymectomy (OT). Recently, most patients with Masaoka stage I-II thymoma have been receiving TT. This procedure is associated with a significantly shorter post-operative hospital stay, decreased intraoperative blood loss, and fewer complications compared with OT. Recurrence rates of thymoma after TT range from 0% to 6.7%, and the 5-year disease-free survival (DFS) ranges from 83.3% to 96%. The oncological outcomes of TT are comparable to that of OT. Masaoka stage and the World Health Organization (WHO) type classification are valuable predictors of the prognosis of thymoma; hence, the optimal treatment for thymoma should be performed according to these two. TT is less invasive, with equivalent oncological outcomes, when compared with the OT. Minimally invasive surgery including TT for stage I-II thymomas is becoming the mainstay of therapy.
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Affiliation(s)
- Makoto Odaka
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo 105-0003, Japan
| | - You Tsukamoto
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo 105-0003, Japan
| | - Takamasa Shibasaki
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo 105-0003, Japan
| | - Shohei Mori
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo 105-0003, Japan
| | - Hisatoshi Asano
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo 105-0003, Japan
| | - Makoto Yamashita
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo 105-0003, Japan
| | - Toshiaki Morikawa
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo 105-0003, Japan
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Marulli G, Comacchio GM, Stocca F, Zampieri D, Romanello P, Calabrese F, Rebusso A, Rea F. Robotic-assisted thymectomy: current perspectives. ACTA ACUST UNITED AC 2016; 3:53-63. [PMID: 30697556 PMCID: PMC6193423 DOI: 10.2147/rsrr.s93012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Thymectomy is the cornerstone in the treatment of thymic tumors and an accepted option for the management of myasthenia gravis. Different surgical approaches have been described, but the gold standard is represented by median sternotomy. In the last two decades, the development of minimally invasive surgery has led to an increased acceptance of thymectomy, especially for benign diseases. Robotic thymectomy seems a further step in the development and evolution of minimally invasive approaches. Since its introduction, different authors described their experience with robotic thymectomy, both for nonthymomatous myasthenia gravis and for thymic tumors. Available data show that robotic thymectomy may be considered a safe and feasible operation. In patients with nonthymomatous myasthenia, robotic thymectomy is effective and the long-term results are encouraging. The role of robotic thymectomy in patients affected by thymoma is still under evaluation, but the intermediate results seem promising both in terms of surgical and oncologic outcomes.
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Affiliation(s)
- Giuseppe Marulli
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Giovanni M Comacchio
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Francesca Stocca
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Davide Zampieri
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Paola Romanello
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Francesca Calabrese
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Alessandro Rebusso
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Federico Rea
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
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Wilshire CL, Vallières E, Shultz D, Aye RW, Farivar AS, Louie BE. Robotic Resection of 3 Cm and Larger Thymomas is Associated with Low Perioperative Morbidity and Mortality. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Eric Vallières
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA USA
| | - Dale Shultz
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA USA
| | - Ralph W. Aye
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA USA
| | | | - Brian E. Louie
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA USA
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Robotic Thymectomy in Anterior Mediastinal Mass: Propensity Score Matching Study With Transsternal Thymectomy. Ann Thorac Surg 2016; 102:895-901. [DOI: 10.1016/j.athoracsur.2016.03.084] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/09/2016] [Accepted: 03/22/2016] [Indexed: 11/21/2022]
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Odaka M, Shibasaki T, Kato D, Mori S, Asano H, Yamashita M, Morikawa T. Comparison of oncological results for early- and advanced-stage thymomas: thoracoscopic thymectomy versus open thymectomy. Surg Endosc 2016; 31:734-742. [DOI: 10.1007/s00464-016-5027-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 06/06/2016] [Indexed: 11/28/2022]
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Hess NR, Sarkaria IS, Pennathur A, Levy RM, Christie NA, Luketich JD. Minimally invasive versus open thymectomy: a systematic review of surgical techniques, patient demographics, and perioperative outcomes. Ann Cardiothorac Surg 2016; 5:1-9. [PMID: 26904425 DOI: 10.3978/j.issn.2225-319x.2016.01.01] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Thymectomy is the mainstay of treatment for thymoma and other anterior mediastinal tumors, and is often utilized in the management of patients with myasthenia gravis (MG). While traditionally approached through a median sternotomy, minimally invasive approaches to thymectomy have increasingly emerged. The present systematic review was conducted to compare perioperative and clinical outcomes following minimally invasive thymectomy (MIT) and open thymectomy (OT). METHODS Articles were obtained through a PubMed literature search. Comparative studies reporting clinical outcomes following MIT and OT were eligible for inclusion. We selected studies with full text availability, written in the English language, published after 2005 and with at least 15 patients in each arm. A descriptive analysis was performed. RESULTS Twenty studies were included, involving a total of 2,068 patients undergoing either MIT (n=838) or OT (n=1,230). Within individual studies, MIT and OT cohorts were well matched with regards to patient age and gender, but there was considerable variation across studies. Resected thymomas were consistently larger in OT groups, with mean diameter significantly larger in five studies (MIT, 29-52 mm; OT, 31-77 mm). MIT was consistently associated with a lower estimated blood loss (MIT, 20-200 mL; OT, 86-466 mL), chest tube duration (MIT, 1.3-4.1 days; OT, 2.4-5.3 days), and hospital length of stay (MIT, 1-10.6 days; OT, 4-14.6 days). There were no consistent differences in rates of perioperative complications, thymoma recurrence, MG complete stable remission, or 5-year survival. CONCLUSIONS In appropriately selected patients, MIT may reduce blood loss, chest tube duration, and hospital length of stay, with comparable clinical outcomes compared to OT via median sternotomy.
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Affiliation(s)
- Nicholas R Hess
- 1 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA ; 2 Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Inderpal S Sarkaria
- 1 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA ; 2 Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arjun Pennathur
- 1 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA ; 2 Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ryan M Levy
- 1 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA ; 2 Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Neil A Christie
- 1 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA ; 2 Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James D Luketich
- 1 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA ; 2 Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Marulli G, Maessen J, Melfi F, Schmid TA, Keijzers M, Fanucchi O, Augustin F, Comacchio GM, Mussi A, Hochstenbag M, Rea F. Multi-institutional European experience of robotic thymectomy for thymoma. Ann Cardiothorac Surg 2016; 5:18-25. [PMID: 26904427 DOI: 10.3978/j.issn.2225-319x.2015.08.13] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Robotic thymectomy for early-stage thymomas has been recently suggested as a technically sound and safe approach. However, due to a lack of data on long term results, controversy still exists regarding its oncological efficacy. In this multi-institutional series collected from four European Centres with high volumes of robotic procedures, we evaluate the results after robot-assisted thoracoscopic thymectomy for thymoma. METHODS Between 2002 and 2014, 134 patients (61 males and 73 females, median age 59 years) with a clinical diagnosis of thymoma were operated on using a left-sided (38%), right-sided (59.8%) or bilateral (2.2%) robotic approach. Seventy (52%) patients had associated myasthenia gravis (MG). RESULTS The average operative time was 146 minutes (range, 60-353 minutes). Twelve (8.9%) patients needed open conversion: in one case, a standard thoracoscopy was performed after robotic system breakdown, and in six cases, an additional access was required. Neither vascular and nerve injuries, nor perioperative mortality occurred. A total of 23 (17.1%) patients experienced postoperative complications. Median hospital stay was 4 days (range, 2-35 days). Mean diameter of resected tumors was 4.4 cm (range, 1-10 cm), Masaoka stage was I in 46 (34.4%) patients, II in 71 (52.9%), III in 11 (8.3%) and IVa/b in 6 (4.4%) cases. At last follow up, 131 patients were alive, three died (all from non-thymoma related causes) with a 5-year survival rate of 97%. One (0.7%) patient experienced a pleural recurrence. CONCLUSIONS Our data suggest that robotic thymectomy for thymoma is a technically feasible and safe procedure with low complication rates and short hospital stays. Oncological outcome appears to be good, particularly for early-stage tumors, but a longer follow-up period and more cases are necessary in order to consider this as a standard approach. Indications for robotic thymectomy for stage III or IVa thymomas are rare and should be carefully evaluated.
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Affiliation(s)
- Giuseppe Marulli
- 1 Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Italy ; 2 Department of Cardiothoracic Surgery, University Medical Centre of Maastricht, Netherlands ; 3 Department of Cardiac, Thoracic and Vascular Surgery, Thoracic Surgery Division, University of Pisa, Italy ; 4 Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Austria
| | - Jos Maessen
- 1 Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Italy ; 2 Department of Cardiothoracic Surgery, University Medical Centre of Maastricht, Netherlands ; 3 Department of Cardiac, Thoracic and Vascular Surgery, Thoracic Surgery Division, University of Pisa, Italy ; 4 Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Austria
| | - Franca Melfi
- 1 Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Italy ; 2 Department of Cardiothoracic Surgery, University Medical Centre of Maastricht, Netherlands ; 3 Department of Cardiac, Thoracic and Vascular Surgery, Thoracic Surgery Division, University of Pisa, Italy ; 4 Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Austria
| | - Thomas A Schmid
- 1 Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Italy ; 2 Department of Cardiothoracic Surgery, University Medical Centre of Maastricht, Netherlands ; 3 Department of Cardiac, Thoracic and Vascular Surgery, Thoracic Surgery Division, University of Pisa, Italy ; 4 Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Austria
| | - Marlies Keijzers
- 1 Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Italy ; 2 Department of Cardiothoracic Surgery, University Medical Centre of Maastricht, Netherlands ; 3 Department of Cardiac, Thoracic and Vascular Surgery, Thoracic Surgery Division, University of Pisa, Italy ; 4 Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Austria
| | - Olivia Fanucchi
- 1 Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Italy ; 2 Department of Cardiothoracic Surgery, University Medical Centre of Maastricht, Netherlands ; 3 Department of Cardiac, Thoracic and Vascular Surgery, Thoracic Surgery Division, University of Pisa, Italy ; 4 Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Austria
| | - Florian Augustin
- 1 Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Italy ; 2 Department of Cardiothoracic Surgery, University Medical Centre of Maastricht, Netherlands ; 3 Department of Cardiac, Thoracic and Vascular Surgery, Thoracic Surgery Division, University of Pisa, Italy ; 4 Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Austria
| | - Giovanni M Comacchio
- 1 Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Italy ; 2 Department of Cardiothoracic Surgery, University Medical Centre of Maastricht, Netherlands ; 3 Department of Cardiac, Thoracic and Vascular Surgery, Thoracic Surgery Division, University of Pisa, Italy ; 4 Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Austria
| | - Alfredo Mussi
- 1 Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Italy ; 2 Department of Cardiothoracic Surgery, University Medical Centre of Maastricht, Netherlands ; 3 Department of Cardiac, Thoracic and Vascular Surgery, Thoracic Surgery Division, University of Pisa, Italy ; 4 Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Austria
| | - Monique Hochstenbag
- 1 Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Italy ; 2 Department of Cardiothoracic Surgery, University Medical Centre of Maastricht, Netherlands ; 3 Department of Cardiac, Thoracic and Vascular Surgery, Thoracic Surgery Division, University of Pisa, Italy ; 4 Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Austria
| | - Federico Rea
- 1 Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Italy ; 2 Department of Cardiothoracic Surgery, University Medical Centre of Maastricht, Netherlands ; 3 Department of Cardiac, Thoracic and Vascular Surgery, Thoracic Surgery Division, University of Pisa, Italy ; 4 Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Austria
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Is Thymomectomy Alone Appropriate for Stage I (T1N0M0) Thymoma? Results of a Propensity-Score Analysis. Ann Thorac Surg 2016; 101:520-6. [DOI: 10.1016/j.athoracsur.2015.07.084] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/21/2015] [Accepted: 07/28/2015] [Indexed: 11/19/2022]
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