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Ke L, Liu J, Shuai Y, Zhu L, He C, Huang X, Lv W, Wang L, Hu J. Intercostal approach VATS is feasible for large-sized anterior mediastinal tumors. Sci Rep 2024; 14:17227. [PMID: 39060332 PMCID: PMC11282267 DOI: 10.1038/s41598-024-67830-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
There is no consensus about whether relatively large mediastinal tumors (≥ 5.0 cm) are suitable for video-assisted thoracoscopic surgery (VATS). Therefore, this study aimed to compare the efficacy and safety of intercostal approach VATS for large-sized anterior mediastinal tumors (5.0-10.0 cm) with no invasion to the surrounding tissues and organs. A total of 129 patients with anterior mediastinal tumors who received surgery in our hospital between January 2018 and July 2022 were consecutively enrolled. Patients were divided into 2 groups based on mediastinal tumor diameter: Group A (tumor size between 1.0 and 4.9 cm) and Group B (tumor size between 5.0 and 10.0 cm). The primary endpoints were operation time, blood loss, and postoperative pain, and the secondary endpoints were the volume of drainage, drainage duration, postoperative hospital stay, and postoperative complications. Significant differences were found in the volume of drainage between the two groups (Group A: 218.4 ± 140.6, Group B: 398.9 ± 369.3, P < 0.001). However, no differences were found in operation time, blood loss, drainage duration, postoperative hospital stay and duration of postoperative oral analgesics (P > 0.05). In addition, there existed no significant differences in the postoperative complications. Intercostal approach VATS is regarded as a feasible and safe surgical method for large-sized anterior mediastinal tumors (5.0-10.0 cm) with no invasion to the surrounding tissues and organs.
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Affiliation(s)
- Lei Ke
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Jiacong Liu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Yongfeng Shuai
- Department of Plastic Surgery, The Second Hospital of Yinzhou, Ningbo, 315000, China
| | - Linhai Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China.
| | - Cheng He
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Xuhua Huang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Wang Lv
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Luming Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China.
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China.
- Key Laboratory of Clinical Evaluation Technology for Medical Device of Zhejiang Province, Hangzhou, 310003, China.
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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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3
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Yang X, Jiang J, Ao Y, Zheng Y, Gao J, Wang H, Liang F, Wang Q, Tan L, Wang S, Ding J. Perioperative outcomes and survival of modified subxiphoid video-assisted thoracoscopic surgery thymectomy for T 2-3 thymic malignancies: A retrospective comparison study. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00367-2. [PMID: 38692477 DOI: 10.1016/j.jtcvs.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/01/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Our previous study demonstrated that modified subxiphoid video-assisted thoracic surgery thymectomy with an auxiliary sternal retractor is feasible for locally invasive thymic malignancies. This study aimed to compare perioperative and oncological outcomes of modified subxiphoid video-assisted thoracoscopic surgery thymectomy versus median sternotomy thymectomy for locally advanced thymic malignancies. METHODS In total, 221 patients with T2-3 thymic malignancies who underwent modified subxiphoid video-assisted thoracoscopic surgery thymectomy or median sternotomy thymectomy between 2015 and 2020 were enrolled in our prospectively maintained database. A 1:1 propensity score-matching analysis was performed to balance the bias. Surgical difficulty was evaluated with a modified resection index. Perioperative and oncological results were compared between the modified subxiphoid video-assisted thoracoscopic surgery thymectomy group and the median sternotomy thymectomy group. RESULTS There were 72 patients in each group in the final analysis. Our results showed that the modified subxiphoid video-assisted thoracoscopic surgery thymectomy group had a shorter operative duration (98 vs 129 minutes, P < .001), less blood loss (40 vs 100 mL, P < .001), shorter drainage duration (3 vs 5 days, P < .001), shorter length of hospital stay (5 vs 6 days, P < .001), and fewer postoperative complications (5.6% vs 23.6%; P = .005). No significant difference was detected in complete resection (98.6% vs 98.6%, P = 1.000) between the 2 groups. Conversion occurred in 5 of 106 patients (4.7%). Survival analyses indicated similar recurrence-free survival (hazard ratio, 0.94; 95% CI, 0.40-2.20; P = .883) and overall survival (hazard ratio, 0.52; 95% CI, 0.05-5.02; P = .590) between the 2 groups. CONCLUSIONS Modified subxiphoid video-assisted thoracoscopic surgery thymectomy was safe and effective for T2-3 thymic malignancies and could be an alternative for selected patients with locally advanced thymic diseases. Further prospective studies are needed to evaluate the long-term survival of those undergoing modified subxiphoid approach thoracoscopic thymectomy.
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Affiliation(s)
- Xinyu Yang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiahao Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yongqiang Ao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuansheng Zheng
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Gao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fei Liang
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuai Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Jianyong Ding
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
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Manyak GA, Bassiri A, Alvarado CE, Sarnaik KS, Sinopoli J, Tapias L, Linden PA, Towe CW. Is Minimally Invasive Resection of Large Thymoma Appropriate? Am Surg 2024:31348241246180. [PMID: 38584508 DOI: 10.1177/00031348241246180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Current practice patterns suggest open rather than minimally invasive (MIS) approaches for thymomas >4 cm. We hypothesized there would be similar perioperative outcomes and overall survival between open and MIS approaches for large (>4 cm) thymoma resection. METHODS The National Cancer Database was queried for patients who underwent thymectomy from 2010 to 2020. Surgical approach was characterized as either open or MIS. The primary outcome was overall survival and secondary outcomes were margin status, and length of stay (LOS). Differences between approach cohorts were compared after a 1:1 propensity match. RESULTS Among 4121 thymectomies, 2474 (60%) were open and 1647 (40%) were MIS. Patients undergoing MIS were older, had fewer comorbidities, and had smaller tumors (median; 4.6 vs 6 cm, P < .001). In the unmatched cohort, MIS and open had similar 90-day mortality (1.1% vs 1.8%, P = .158) and rate of positive margin (25.1% vs 27.9%, P = .109). MIS thymectomy was associated with shorter LOS (2 (1-4) vs 4 (3-6) days, P < .001). Propensity matching reduced the bias between the groups. In this cohort, overall survival was similar between the groups by log-rank test (P = .462) and multivariate cox hazard analysis (HR .882, P = .472). Multivariable regression showed shorter LOS with MIS approach (Coef -1.139, P < .001), and similar odds of positive margin (OR 1.130, P = .150). DISCUSSION MIS has equivalent oncologic benefit to open resection for large thymomas, but is associated with shorter LOS. When clinically appropriate, MIS thymectomy may be considered a safe alternative to open resection for large thymomas.
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Affiliation(s)
- Grigory A Manyak
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, OH, USA
- Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Aria Bassiri
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Christine E Alvarado
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Kunaal S Sarnaik
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, OH, USA
- Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Jilian Sinopoli
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Leonidas Tapias
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Philip A Linden
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, OH, USA
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Tang M, Liu J, Shuai Y, Wang L, Huang X, Lv W, Lin X, Zhu L, Hu J. Clinical evaluation of the impact of mediastinal tumour size on the subxiphoid approach video-assisted thoracoscopic surgery. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae015. [PMID: 38268477 DOI: 10.1093/icvts/ivae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/29/2023] [Accepted: 01/22/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVES The application of video-assisted thoracoscopic surgery (VATS) for relatively large mediastinal tumours (≥5.0 cm) has been a subject of debate, and few studies have investigated the subxiphoid approach VATS in different tumour size categories. The study aims to compare the efficacy of the subxiphoid approach VATS for achieving curative outcomes based on tumour size categories (<3.0, 3.0-4.9 and 5.0-10.0 cm). METHODS A total of 165 patients with anterior mediastinal tumours who underwent surgery at our hospital between January 2018 and July 2022 were consecutively enrolled, categorized according to tumour size-group A (<3.0 cm): 58, group B (3.0-4.9 cm): 70 and group C (5.0-10.0 cm): 37. Clinical baseline data, intraoperative and postoperative outcomes, and postoperative complications were analysed. RESULTS The study revealed significant differences in operation time among the 3 groups (group A: 103.4 ± 36.1, group B: 106.4 ± 35.2, group C: 127.4 ± 44.8; P < 0.05) as well as in the volume of drainage (group A: 273.3 ± 162.0, group B: 411.9 ± 342.6, group C: 509.7 ± 543.7; P < 0.05). However, no differences were seen in blood loss, drainage duration, postoperative hospital stay and duration of postoperative oral analgesics. Additionally, the incidence of postoperative complications did not exhibit significant differences across these groups. CONCLUSIONS Subxiphoid approach VATS is considered a feasible and safe surgical method for large-sized anterior mediastinal tumours (5.0-10.0 cm) with no invasion to the surrounding tissues and organs.
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Affiliation(s)
- Muhu Tang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiacong Liu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yongfeng Shuai
- Department of Plastic Surgery, The Second Hospital of Yinzhou, Ningbo, China
| | - Luming Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuhua Huang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wang Lv
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xu Lin
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linhai Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Clinical Evaluation Technology for Medical Device of Zhejiang Province, Hangzhou, China
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Lee J, Cho S, Yoon SH, Shih BCH, Jung W, Jeon JH, Kim K, Jheon S. Surgical outcomes of thoracoscopic thymectomy via the single-port subxiphoid approach versus the unilateral intercostal approach. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad141. [PMID: 37792493 PMCID: PMC10561956 DOI: 10.1093/icvts/ivad141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/03/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES The purpose of this study was to explore the safety and feasibility of video-assisted thoracic surgery (VATS) total thymectomy via the single-port subxiphoid approach compared with the intercostal approach. METHODS From January 2018 to May 2022, patients who underwent VATS total thymectomy via the subxiphoid or unilateral intercostal approach and diagnosed with Masaoka-Koga stage I-II, non-myasthenic thymoma were included in this study. Perioperative outcomes, immediate and long-term pain evaluations were compared in a propensity score-matching analysis. RESULTS In total, 95 patients were included and underwent the subxiphoid approach (n = 37) and the intercostal approach (n = 58). Propensity score yielded 2 well-matched cohorts of 30 patients and there was no significant demographical imbalance between the 2 groups. Compared with the intercostal approach, the subxiphoid group demonstrated favourable perioperative outcomes including the intraoperative blood loss (P = 0.025) and the median duration of hospital stay (P = 0.083). The immediate and long-term pain evaluations revealed that the subxiphoid group reported lower visual analogue scales at postoperative 24 h and lower total doses of fentanyl bolus infusions during hospitalization (P = 0.004 and 0.018, respectively), along with lower long-term neuropathic pain scale scores (P = 0.005) than patients in the intercostal group. CONCLUSIONS VATS thymectomy via the single-port subxiphoid approach showed favourable perioperative outcomes compared to the intercostal approach. Moreover, the subxiphoid approach seemed both to cause minimal immediate postoperative pain and to have advantages in reducing long-term neuropathic pain compared with the intercostal approach.
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Affiliation(s)
- Joonseok Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Hwan Yoon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Beatrice Chia-Hui Shih
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Woohyun Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jae Hyun Jeon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Inoue M, Yamamoto H, Okada Y, Sato T, Sato Y, Suzuki K, Yoshino I, Chida M. Perioperative outcomes of minimally invasive surgery for large malignant thymic epithelial tumors and for total thymectomy. Surg Today 2023; 53:1089-1099. [PMID: 36867230 DOI: 10.1007/s00595-023-02667-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/31/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE Minimally invasive surgery (MIS) for thymic tumors is now accepted widely, in line with improved surgical techniques; however, we occasionally encounter complicated cases of large tumors or of total thymectomy requiring prolonged operative duration or conversion to an open procedure (OP). We reviewed patients registered in a nationwide database to identify the technical feasibility of MIS for thymic epithelial tumors. METHODS Data on patients treated surgically between 2017 and 2019 were extracted from the National Clinical Database of Japan. Clinical factors and operative outcomes were calculated by tumor diameter using trend analyses. Perioperative outcomes of MIS for non-invasive thymoma were investigated using propensity score-matched analyses. RESULTS MIS was performed in 46.2% of the patients. The operative duration and conversion rate increased with the tumor diameter (p < .001). After propensity score-matching, operative duration and postoperative hospital stay were shorter (p < .001), and the transfusion rate was lower (p = .007) in patients who underwent MIS than in those who underwent OP for thymomas ≥ 5 cm. Among patients who underwent total thymectomy, blood loss was less (p < .001) and the postoperative hospital stay was shorter (p < .001) in those who underwent MIS than in those who underwent OP. There were no significant differences in postoperative complications and mortality. CONCLUSIONS MIS is technically feasible even for large non-invasive thymomas or for total thymectomy, although the operative duration and open conversion rate increase with the tumor diameter.
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Affiliation(s)
- Masayoshi Inoue
- Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kamigyo-Ku, Kyoto City, 602-8566, Japan.
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai City, Japan
| | - Toshihiko Sato
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka City, Japan
| | - Yukio Sato
- Department of Thoracic Surgery, University of Tsukuba, Tsukuba City, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba City, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan
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Zhang Y, Lin D, Aramini B, Yang F, Chen X, Wang X, Wu L, Huang W, Fan J. Thymoma and Thymic Carcinoma: Surgical Resection and Multidisciplinary Treatment. Cancers (Basel) 2023; 15:cancers15071953. [PMID: 37046614 PMCID: PMC10093507 DOI: 10.3390/cancers15071953] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
Thymoma and thymic carcinoma are the most common tumors of the anterior mediastinum and a relatively rare type of thoracic cancer. The prerequisite for surgery is clinical staging and operative evaluation, both of which are based on medical imaging. The best strategy for treating a thymic epithelial tumor is surgical resection of the organ and surrounding tissue. Thymectomy modalities vary, including open surgery and minimally invasive surgery, and surgeons have used various innovations to better meet the needs of the procedure; therefore, it is critical to select the appropriate procedure based on the patient's characteristics. Evaluation of resectability is the first step of surgical resection for thymic tumors without distant metastasis. The decision regarding unresectability should be made carefully. During subsequent chemotherapy or chemoradiotherapy, reevaluation of whether an area is resectable or not remains essential. Despite numerous technological advances in the surgical treatment of thymic tumors, several contentious issues remain, including the selection of surgical approaches for difficult cases, the selection of video-assisted thoracoscopic approaches, the evaluation of resectability, minimally invasive surgery for locally advanced thymic tumors, lymphadenectomy in thymic tumors, neoadjuvant therapy for thymic tumors, debulking surgery, and salvage surgery. In solving these problems, the surgeon's judgment, surgical experience, and surgical skills are especially important.
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Affiliation(s)
- Yue Zhang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Dong Lin
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Beatrice Aramini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences-DIMEC of the Alma Mater Studiorum, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 47121 Forlì, Italy
| | - Fu Yang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xi Chen
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xing Wang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Liang Wu
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Wei Huang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jiang Fan
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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9
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Current and Future Issues in the Surgical Treatment of Thymic Epithelial Tumors: a Review. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03716-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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10
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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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11
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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: 6] [Impact Index Per Article: 3.0] [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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12
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Li B, Niu L, Gu C, He K, Wu R, Pan Z, Chen S. Clinical analysis of subxiphoid vs. lateral approaches for treating early anterior mediastinal thymoma. Front Surg 2022; 9:984043. [PMID: 36338633 PMCID: PMC9632990 DOI: 10.3389/fsurg.2022.984043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the clinical efficacy of the subxiphoid approach for early anterior mediastinal thymoma and evaluate its advantages over the lateral intercostal approach. Methods A total of 345 patients with early anterior mediastinal thymoma were retrospectively analyzed from January 2016 to December 2020 in the First Affiliated Hospital of Soochow University. Out of these, 99 patients underwent subxiphoid video-assisted thoracoscopic thymectomy and 246 patients underwent transthoracic video-assisted thoracoscopic thymectomy. We compared the intraoperative conditions (such as operation time and intraoperative blood loss), postoperative conditions [such as postoperative pleural drainage volume, extubation time, postoperative hospital stay, and postoperative visual analogue scale (VAS) pain score], and postoperative complications (such as death, pneumonia, delayed wound healing, cardiac arrhythmia, and phrenic nerve injury) of the two groups and analyzed the clinical advantages of the subxiphoid approach for treating early anterior mediastinal thymoma. Results There was no significant difference between the two groups in terms of general clinical features, operation time, and postoperative complications (P > 0.05).However, there was a significant difference in terms of intraoperative blood loss, postoperative pleural drainage volume, tube extubation time, postoperative hospital stay, postoperative VAS pain score, and postoperative analgesics (a significantly decreased flurbiprofen axetil amount) (P < 0.05). Conclusion Compared with the lateral intercostal thoracic approach, the subxiphoid approach had advantages in terms of intraoperative blood loss, postoperative hospital stay, tube extubation time, postoperative pleural drainage volume, postoperative VAS pain score, and analgesics dosage. It could provide a better view of the bilateral pleural cavities and more thorough thymectomy and superior cosmesis, and it proved to be a safe and feasible minimally invasive surgical method.
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Affiliation(s)
- Bin Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lijuan Niu
- Department of Endocrinology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chenqi Gu
- Department of Imaging, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Kaiwen He
- Department of Thoracic Surgery, Changshu No.1 People's Hospital, Changshu, China
| | - Ruizhi Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhenfeng Pan
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
- Correspondence: Shaomu Chen Zhenfeng Pan
| | - Shaomu Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Correspondence: Shaomu Chen Zhenfeng Pan
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13
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Zhu X, Jin K, Wu X, Yu G. Clinical Application of Thoracoscopic Resection of Anterior Mediastinal Tumors under the Xiphoid Process. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2012457. [PMID: 36051485 PMCID: PMC9427266 DOI: 10.1155/2022/2012457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/18/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022]
Abstract
Objective To explore the feasibility and advantages of thoracoscopic resection of anterior mediastinal tumors through subxiphoid and lateral thoracic approaches. Method 74 patients with anterior mediastinal tumors hospitalized in our hospital from January 2019 to January 2022 were retrospectively analyzed. They were divided into the lateral chest group (31 cases) and the infraxiphoid group (43 cases) according to different operation methods. The tumor size, operation time, intraoperative bleeding, postoperative pain score, postoperative complications, postoperative drainage tube removal time, and hospital stay were compared between the two groups. Result The intraoperative bleeding and postoperative pain scores in the subxiphoid group were better than those in the lateral chest group. There was no significant difference in operation time and postoperative complications between the two groups. Conclusion Compared with the lateral thoracic approach, the thoracoscopic subxiphoid approach can be more safe and effective in resectioning anterior mediastinal tumors.
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Affiliation(s)
- Xingfeng Zhu
- Department of Thoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214023, China
| | - Kuanzhe Jin
- Department of Thoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214023, China
| | - Xiaobo Wu
- Department of Thoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214023, China
| | - Guiping Yu
- Department of Cardiothoracic Surgery, Jiangyin Clinical College of Xuzhou Medical University, Wuxi, Jiangsu 214400, China
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14
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Robotic Mediastinal Tumor Resections: Position and Port Placement. J Pers Med 2022; 12:jpm12081195. [PMID: 35893289 PMCID: PMC9330394 DOI: 10.3390/jpm12081195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to determine the optimal position and port placement during robotic resection for various mediastinal tumors. For anterior mediastinal tumors, total or extended thymectomy is commonly performed in the supine position using the lateral or subxiphoid approach. Although it is unclear which approach is better during robotic thymectomy, technical advantages of subxiphoid approach are beneficial for patients with myasthenia who require extended thymectomy. Partial thymectomy is performed in the supine position using a lateral approach. Superior, middle, and posterior mediastinal tumors are resected in the decubitus position using the lateral approach, whereas dumbbell tumor resection, which requires a posterior approach, can be performed in the prone position. The position and port placement should be chosen depending on the size, location, and aggressiveness of the tumor. In this study, we describe how to choose which of these different robotic approaches can be used based on our experience and previous reports.
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15
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Kas J, Bogyó L, Fehér C, Ghimessy Á, Gieszer B, Karskó L, Kecskés L, Lungu V, Mészáros L, Pataki Á, Radetzky P, Szegedi R, Tallósy B, Török K, Vágvölgyi A, Fillinger J, Harkó T, Soltész I, Tóth E, Rózsa C, Elek J, Ganovszky E, Agócs L, Rényi-Vámos F, Kocsis Á. Unilateral video-assisted thoracoscopic thymoma resection – Indications, early and mid-term results. Magy Seb 2022; 75:79-95. [PMID: 35895535 DOI: 10.1556/1046.2022.20001] [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: 12/19/2021] [Accepted: 01/21/2022] [Indexed: 11/19/2022]
Abstract
Introduction. Thymoma is the most common tumour of the anterior mediastinum. Video-Assisted Thoracic Surgery technique of thymoma resection is spreading world-wide, but the thoracoscopic method is still contentious in many ways. Authors evaluate the early and mid-term results of a 17 years period of VATS unilateral approach at 2 Hungarian thoracic surgical centers. Method. Depending on the anatomical situation of the thymoma, we performed thymectomy, or partial thymectomy (thymomectomy) for the Masaoka–Koga I–II–III stage thymoma from the right or left side through 2 or 3 intercostal ports. We managed the operations with ultrasonic dissector and electrocauter. By using international standards we evaluated perioperative morbidity, mid-term oncological results and clinical symptoms of myasthenia. Results. 23 of the 54 patients were man, 31 were woman, the average age was 58 (26–79) years, 23 of them had myasthenia. The conversion rate was 11,5% (7/61). The average operation time was 84 (39–150) minutes. The average hospitalisation time was 5.5 (3–19) days. The average size of the thymomas was 46 (18–90) mm. The histology resulted thymoma type A in 2 cases, AB in 19 cases, B1/2/3 in 11/11/1 cases, mixed B in 10 cases. The examination of the resection line was R0/1/2 in 42/11/1 cases. The Masaoka–Koga stages were: I (17), IIA (28), IIB (2), III (7). There was 25 thymomectomies, and 29 thymectomies. In seven cases there were extension of the operation to the pericardium (2), to the lung (2), to the phrenic nerve (6), and to innominate vein (1). The in-hospital mortality over 30 day was in 1 case (1.85%). The morbidity was 11/54 (20.4%). The average follow-up time was 62.56 (5–198) months. In the group with myasthenia the effectivity of the operation was 18/21 (85.7%), including complete remission of 5/21 (23.8%). Post-thymectomy myasthenia gravis developed in 2/31 cases (6.5%). The average 5 years survival was 100%, tumour-free 5 years survival was 96%. Conclusions. The higher proportion of the thymomectomy in the early results, higher conversion rate and lower R0 proportion might be in connection with the attitude of the surgeons, with the learning curve and with the limitations of the unilateral method. After a longer follow-up time late results may become more real and comparable. Instead of unilateral VATS technique we have changed to the subxyphoideal approach of VATS because of its better visualisation.
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Affiliation(s)
- József Kas
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos)
| | - Levente Bogyó
- 2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Csaba Fehér
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos)
| | - Áron Ghimessy
- 2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Balázs Gieszer
- 2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Luca Karskó
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos)
| | - Lóránt Kecskés
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos)
| | - Viktor Lungu
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos)
| | - László Mészáros
- 2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Ágoston Pataki
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos)
| | - Péter Radetzky
- 2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Róbert Szegedi
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos)
| | - Bernadett Tallósy
- 2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Klári Török
- 2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Attila Vágvölgyi
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos)
| | - János Fillinger
- 3 Országos Korányi Pulmonológiai Intézet, Patológia, Budapest, Magyarország (osztályvezető: dr. Fillinger János)
| | - Tünde Harkó
- 3 Országos Korányi Pulmonológiai Intézet, Patológia, Budapest, Magyarország (osztályvezető: dr. Fillinger János)
| | - Ibolya Soltész
- 3 Országos Korányi Pulmonológiai Intézet, Patológia, Budapest, Magyarország (osztályvezető: dr. Fillinger János)
| | - Erika Tóth
- 4 Országos Onkológiai Intézet, Daganatpatológiai Központ (központvezető: dr. Szőke János, osztályvezető: dr. Tóth Erika)
| | - Csilla Rózsa
- 5 Jahn Ferenc Dél-pesti Kórház és Rendelőintézet, Budapest, Magyarország (főigazgató: dr. Ralovich Zsolt), Neurológia (osztályvezető: dr. Rózsa Csilla)
| | - Jenő Elek
- 6 Országos Korányi Pulmonológiai Intézet, AITO, Budapest, Magyarország (osztályvezető: dr. Elek Jenő).,7 Országos Onkológiai Intézet, AITO, Budapest, Magyarország (osztályvezető: dr. Elek Jenő)
| | - Erna Ganovszky
- 8 Országos Onkológiai Intézet, Gyógyszerterápiás Központ, Budapest, Magyarország (központvezető: dr. Géczi Lajos, osztályvezető: dr. Rubovszky Gábor László)
| | - László Agócs
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos).,2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Ferenc Rényi-Vámos
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos).,2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Ákos Kocsis
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos).,2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
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Dukmak ON, Dweik R, Hashlamoun N, Qawasmeh R, Al Mohtasib ME, Asbeh YA. A case of uniportal VATS thymectomy for Thymoma associated with myasthenia gravis and toxic multinodular goiter. Int J Surg Case Rep 2022; 95:107183. [PMID: 35594786 PMCID: PMC9121269 DOI: 10.1016/j.ijscr.2022.107183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/06/2022] [Accepted: 05/08/2022] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Thymoma is a rare neoplasm, which may be associated with autoimmune disorders, the occurrence of hyperthyroidism in the patients with thymoma is rare. CLINICAL PRESENTATION Here we present an extremely rare case of a 56-year-old female patient who was discovered to have malignant thymoma with associated myasthenia gravis and hyperthyroidism due to toxic multinodular goiter. Our patient started to complain of difficulty breathing and swallowing, Chest CT scan was done and revealed an anterior mediastinal mass, measures about 4.1 × 3.1 × 2.2 cm with enlarged lymph node mostly representing thymoma. Complete thymectomy was performed via uniportal video-assisted thoracoscopic surgery, and the patient's postoperative recovery was uneventful. Microscopic histopathology findings corresponded to thymoma type B1. CONCLUSION The coexistence of thymoma, MG and toxic multinodular goiter is extremely rare. MG should always be suspected in a patient with thymoma. VATS thymectomy has been increasingly used to treat thymoma as it has several advantages over open surgery.
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Affiliation(s)
- Osama N Dukmak
- Faculty of Medicine, Al-Quds University, West Bank, Palestine.
| | - Ruba Dweik
- Faculty of Medicine, Al-Quds University, West Bank, Palestine
| | | | - Rahaf Qawasmeh
- Faculty of Medicine, Al-Quds University, West Bank, Palestine
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17
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Lee JO, Lee GD, Kim HR, Kim DK, Park SI, Cho JH, Kim HK, Choi YS, Kim J, Shim YM, Park S, Park IK, Kang CH, Kim YT, Park SY, Lee CY, Lee JG, Kim DJ, Paik HC. An Overview of Surgical Treatment of Thymic Epithelial Tumors in Korea: A Retrospective Multicenter Analysis. J Chest Surg 2022; 55:126-142. [PMID: 35370141 PMCID: PMC9005939 DOI: 10.5090/jcs.21.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/15/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background Thymic epithelial tumors (TETs) are rare, and information regarding their surgical outcomes and prognostic factors has rapidly changed in the past few decades. We analyzed surgical treatment practices for TETs and outcomes in terms of overall survival (OS) and freedom from recurrence (FFR) during a 13-year period in Korea. Methods In total, 1,298 patients with surgically resected TETs between 2000 and 2013 were enrolled retrospectively. OS and FFR were calculated using the Kaplan-Meier method and evaluated with the log-rank test. Prognostic factors for OS and FFR were analyzed with multivariable Cox regression. Results A total of 1,098 patients were diagnosed with thymoma, and 200 patients were diagnosed with thymic carcinoma. Over the study period, the total number of patients with surgically treated TETs and the proportion of patients who underwent minimally invasive thymic surgery (MITS) increased annually. The 5-year and 10-year survival rates of surgically treated TETs were 91.0% and 82.1%, respectively. The 5-year and 10-year recurrence rates were 86.3% and 80.0%, respectively. The outcomes of surgically treated TETs improved over time. Multivariable Cox hazards analysis for OS, age, tumor size, and Masaoka-Koga stage were independent predictors of prognosis. The World Health Organization classification and tumor-node-metastasis (TNM) staging were also related to the prognosis of TETs. Conclusion Surgical treatment of TETs achieved a good prognosis with a recent increase in MITS. The M-K stage was the most important prognostic factor for OS and FFR. The new TNM stage could also be an effective predictor of the outcomes of TETs.
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Affiliation(s)
- Jun Oh Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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18
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Ramcharran H, Wallen J. Robotic-assisted thoracoscopic resection of anterior mediastinal cystic teratoma: a case report and literature review. J Cardiothorac Surg 2022; 17:67. [PMID: 35382841 PMCID: PMC8985258 DOI: 10.1186/s13019-022-01806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background Mediastinal teratomas are rare tumors that frequently occur in the anterior mediastinum. The majority of these tumors are benign and slow growing. Due to their low malignant potential, the treatment for these tumors is surgical resection. More recently, the surgical management has shifted from invasive approaches such as a sternotomy to minimally invasive ones such as robotic-assisted thoracoscopic resections utilizing lung isolation ventilation. We present a rare case of a locally advanced mediastinal teratoma requiring resection, which was initially attempted thoracoscopically using double lung ventilation. Case presentation A 43 year-old female was found to have an anterior mediastinal mass during work-up for an intermittent cough in 2009. Chest imaging and biopsy at the time showed evidence of a cystic teratoma without concerning features. She underwent imaging surveillance until 2018, when repeat chest imaging showed increasing growth and worrisome radiologic features concerning for malignant degeneration. She underwent an elective robotic-assisted thoracoscopic resection utilizing double lung ventilation, but due to extensive involvement of the right lung, pericardium, superior vena cava, and right phrenic nerve the patient had to be repositioned and started on single lung ventilation mid-procedure to facilitate a safe and complete resection. Conclusions Anterior mediastinal teratomas can be successfully removed by robotic-assisted thoracoscopic resections utilizing single lung ventilation. Though robotic-assisted thoracoscopic resection utilizing double lung ventilation can be effective in performing certain procedures such as lung wedge resections, thymectomy, pleural biopsies and minimally invasive cardiac procedures, it is limited in removing locally advanced mediastinal tumors.
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Affiliation(s)
- Harry Ramcharran
- Department of Thoracic Surgery, SUNY Upstate Medial University, 750 East Adams Street, Syracuse, NY, 13210, USA.
| | - Jason Wallen
- Department of Thoracic Surgery, SUNY Upstate Medial University, 750 East Adams Street, Syracuse, NY, 13210, USA
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19
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6571693. [DOI: 10.1093/ejcts/ezac238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/10/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
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20
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Cao P, Hu S, Qu W, Kong K, Han P, Yue J, Deng Y, Fu X, Li F, Zhao B. Subxiphoid-subcostal thoracoscopic thymectomy for seropositive myasthenia offers equivalent remission rates and potentially faster recovery. Interact Cardiovasc Thorac Surg 2021; 34:576-583. [PMID: 34792156 PMCID: PMC8972302 DOI: 10.1093/icvts/ivab294] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/08/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peng Cao
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shan Hu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wensheng Qu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kangle Kong
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Han
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaqi Yue
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Deng
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Li
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Zhao
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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21
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Guerrera F, Falcoz PE, Moser B, van Raemdonck D, Bille' A, Toker A, Spaggiari L, Ampollini L, Filippini C, Thomas PA, Verdonck B, Mendogni P, Aigner C, Voltolini L, Novoa N, Patella M, Mantovani S, Bravio IG, Zisis C, Guirao A, Londero F, Congregado M, Rocco G, Du Pont B, Martucci N, Esch M, Brunelli A, Detterbeck FC, Venuta F, Weder W, Ruffini E, Klepetko W, Olland A, Du Pont B, Nonaka D, Ozkan B, Lo Iacono G, Braggio C, Filosso PL, Brioude G, van Schil P, Nosotti M, Valdivia D, Bongiolatti S, Inci I, Dimitra R, Sànchez D, Grossi W, Moreno-Merino S, Teschner M. Thymomectomy plus total thymectomy versus simple thymomectomy for early-stage thymoma without myasthenia gravis: a European Society of Thoracic Surgeons Thymic Working Group Study. Eur J Cardiothorac Surg 2021; 60:881-887. [PMID: 34023891 DOI: 10.1093/ejcts/ezab224] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Resection of thymic tumours including the removal of both the tumour and the thymus gland (thymothymectomy; TT) is the procedure of choice and is recommended in most relevant articles in the literature. Nevertheless, in recent years, some authors have suggested that resection of the tumour (simple thymomectomy; ST) may suffice from an oncological standpoint in patients with early-stage thymoma who do not have myasthenia gravis (MG) (non-MG). The goal of our study was to compare the short- and long-term outcomes of ST versus TT in non-MG early-stage thymomas using the European Society of Thoracic Surgeons thymic database. METHODS A total of 498 non-MG patients with pathological stage I thymoma were included in the study. TT was performed in 466 (93.6%) of 498 patients who had surgery with curative intent; ST was done in 32 (6.4%). The completeness of resection, the rate of complications, the 30-day mortality, the overall recurrence and the freedom from recurrence were compared. We performed crude and propensity score-adjusted comparisons by surgical approach (ST vs TT). RESULTS TT showed the same rate of postoperative complications, 30-day mortality and postoperative length of stay as ST. The 5-year overall survival rate was 89% in the TT group and 55% in the ST group. The 5-year freedom from recurrence was 96% in the TT group and 79% in the ST group. CONCLUSION Patients with early-stage thymoma without MG who have a TT show significantly better freedom from recurrence than those who have an ST, without an increase in postoperative morbidity rate.
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Affiliation(s)
- Francesco Guerrera
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e Della Scienza di Torino, Torino, Italy.,Department of Surgical Sciences, University of Torino, Torino, Italy
| | | | - Bernhard Moser
- Department of Thoracic Surgery, Vienna University Hospital, Vienna, Austria
| | - Dirk van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Andrea Bille'
- Department of Thoracic Surgery, Guy's Hospital London, London, UK.,Division of Cancer Studies, King's College London, Guy's Hospital London, London, UK
| | - Alper Toker
- Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, IRCCS, Milano, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
| | - Luca Ampollini
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Milano, Italy
| | - Claudia Filippini
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | | | - Bram Verdonck
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Paolo Mendogni
- Department of Thoracic Surgery, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Clemens Aigner
- Department of Thoracic Surgery, Essen University Hospital - Ruhrlandklinik, Essen, Germany
| | - Luca Voltolini
- Department of Thoracic Surgery, Careggi University Hospital, Firenze, Italy
| | - Nuria Novoa
- Thoracic Surgery Service, Salamanca University Hospital and School of Medicine, Salamanca, Spain
| | - Miriam Patella
- Department of Thoracic Surgery, Zurich University Hospital, Zurich, Switzerland
| | - Sara Mantovani
- Division of Thoracic Surgery and Lung Transplant, Sapienza University of Rome and AOU Policlinico Umberto I, Roma, Italy
| | - Ivan Gomes Bravio
- Department of Thoracic Surgery, Francisco Gentil Portuguese Institute of Oncology CUF Infante Santo Hospital, Lisboa, Portugal
| | - Charalambos Zisis
- Department of Thoracic Surgery, Athens Evangelismos Hospital, Athens, Greece
| | - Angela Guirao
- Department of Thoracic Surgery, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Francesco Londero
- Thoracic Surgery Unit-Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Udine, Italy
| | - Miguel Congregado
- General Thoracic Surgery Department, Virgen Macarena University Hospital and University of Seville, Seville, Spain
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bert Du Pont
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Nicola Martucci
- Division of Thoracic Surgery, Department of Thoracic Surgery and Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Matthias Esch
- Department of Thoracic Surgery, Josef Hospital Delmenhorst, Delmenhorst, Germany
| | | | - Frank C Detterbeck
- Section of Thoracic Surgery, Department of Surgery, Yale Thoracic Oncology Program, Yale University School of Medicine, New Haven, CT, USA
| | - Federico Venuta
- Division of Thoracic Surgery and Lung Transplant, Sapienza University of Rome and AOU Policlinico Umberto I, Roma, Italy
| | - Walter Weder
- Department of Thoracic Surgery, Zurich University Hospital, Zurich, Switzerland
| | - Enrico Ruffini
- Department of Surgical Sciences, University of Torino, Torino, Italy.,Department of Surgical Sciences, Strasbourg University Hospital, Strasbourg, France
| | | | - Walter Klepetko
- Department of Thoracic Surgery, Vienna University Hospital, Vienna, Austria
| | - Anne Olland
- Department of Surgical Sciences, Strasbourg University Hospital, Strasbourg, France
| | - Bert Du Pont
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Daisuke Nonaka
- Section of Thoracic Surgery, Department of Surgery, Yale Thoracic Oncology Program, Yale University School of Medicine, New Haven, CT, USA
| | - Berker Ozkan
- Department of Pathology, Guy's Hospital London, London, UK
| | - Giorgio Lo Iacono
- Division of Thoracic Surgery, European Institute of Oncology, IRCCS, Milano, Italy
| | - Cesare Braggio
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Milano, Italy
| | - Pier Luigi Filosso
- Department of Surgical Sciences, University of Torino, Torino, Italy.,Department of Surgical Sciences, Strasbourg University Hospital, Strasbourg, France
| | - Geoffrey Brioude
- Department of Thoracic Surgery, North Hospital Aix-Marseille University, Marseille, France
| | - Paul van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Mario Nosotti
- Department of Thoracic Surgery, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniel Valdivia
- Department of Thoracic Surgery, Essen University Hospital - Ruhrlandklinik, Essen, Germany
| | | | - Ilhan Inci
- Department of Thoracic Surgery, Zurich University Hospital, Zurich, Switzerland
| | - Rontogianni Dimitra
- Department of Thoracic Surgery, Istanbul Medical School, Turkey.,Department of Pathology, Athens Evangelismos Hospital, Greece
| | - David Sànchez
- Department of Thoracic Surgery, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - William Grossi
- Thoracic Surgery Unit-Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Udine, Italy
| | - Sergio Moreno-Merino
- General Thoracic Surgery Department, Virgen Macarena University Hospital and University of Seville, Seville, Spain
| | - Martin Teschner
- Department of Thoracic Surgery, Athens Evangelismos Hospital, Athens, Greece
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22
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Podobed AV. [Long-term outcomes of thoracoscopic thymectomy for thymoma stage i-ii]. Khirurgiia (Mosk) 2021:58-62. [PMID: 34363446 DOI: 10.17116/hirurgia202108158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare long-term outcomes of video-assisted thoracoscopic (VATS) and conventional open surgery in patients with early-stage (Masaoka stage I-II) thymic malignancies. MATERIAL AND METHODS. A Retrospective study included patients after VATS and open thymectomy for the period 2000-2019. Long-term outcomes were analyzed. RESULTS VATS thymectomy was performed in 53 (54.1%) patients, open thymectomy - in 45 (45.9%) cases. Median follow-up period was 66.9 months. Overall 5-year survival was 89.8% and 97% in the Open and VATS groups, respectively (p=0.076). Disease-free survival rates were 79.6% and 86.6% (p=0.279), respectively. There was no significant difference in cumulative incidence of recurrence (13.3% vs 7.5%, p=0.505). Age <50 years and tumor size >5 cm were the independent risk factors of recurrence. CONCLUSION VATS thymectomy is an effective approach ensuring similar long-term outcomes in patients with early stages of thymic malignancies.
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Affiliation(s)
- A V Podobed
- Alexandrov National Cancer Center of Belarus, Lesnoy, Belarus
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23
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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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24
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Wu WJ, Zhang FY, Xiao Q, Li XK. Does robotic-assisted thymectomy have advantages over video-assisted thymectomy in short-term outcomes? A systematic view and meta-analysis. Interact Cardiovasc Thorac Surg 2021; 33:385-394. [PMID: 33997899 DOI: 10.1093/icvts/ivab109] [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: 12/09/2020] [Revised: 01/27/2021] [Accepted: 03/09/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES A thymic epithelial tumour is the most common primary tumour in the anterior mediastinum of adults. A few retrospective studies compared the short-term outcomes between robotic-assisted thymectomy (RAT) and video-assisted thymectomy (VAT). So, it is necessary to conduct a meta-analysis to further compare these 2 surgical techniques. METHODS EMBASE, Medline and Web of Science were used. Thesaurus terms and medical subject headings were used in Medline and EMBASE, respectively. The Newcastle-Ottawa scale was used for grading because the included studies were all case-control studies. RESULTS Nine studies were included in the meta-analysis with a total of 723 patients, including 315 patients in the RAT group and 408 patients in the VAT group. The meta-analysis [odds ratio (OR) 0.24, 95% confidence interval (CI) 0.06-0.94; P = 0.041], indicating that RAT yielded a significantly lower rate of conversion compared with VAT. Duration of drainage with RAT was significantly less than that with VAT (weighted mean difference = -1.10; 95% CI -1.98 to -0.22; P = 0.014). The pooled analysis (weighted mean difference = -103.6; 95% CI -199.21 to -7.98; P = 0.034) suggested that patients in the RAT group had less drainage than those in the VAT group. The recurrence rates in both groups were comparable (OR 0.19, 95% CI 0.03-1.20; P = 0.078). CONCLUSIONS RAT has advantages over VAT in terms of short-term outcomes such as shorter duration of drainage, less total drainage and a lower rate of conversion. The recurrence rate was comparable between the 2 techniques. Therefore, RAT could be considered as an alternative treatment for diseases of the thymus.
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Affiliation(s)
- Wen-Jie Wu
- Department of Clinical Medicine, School of Medicine, Southeast University, Nanjing, China
| | - Fu-Yu Zhang
- Department of Clinical Medicine, School of Medicine, Southeast University, Nanjing, China
| | - Qin Xiao
- Department of Clinical Medicine, School of Medicine, Southeast University, Nanjing, China
| | - Xiao-Kun Li
- Department of Clinical Medicine, School of Medicine, Southeast University, Nanjing, China.,Department of Cardiothoracic Surgery, Jinling Hospital, Medicine School of Southeast University, Nanjing, China
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25
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Zeng L, Wang W, Han J, Zhu L, Zhao J, Tu Z. Uniportal video-assisted thoracoscopic surgery and robot-assisted thoracoscopic surgery are feasible approaches with potential advantages in minimally invasive mediastinal lesions resection. Gland Surg 2021; 10:101-111. [PMID: 33633967 DOI: 10.21037/gs-20-536] [Citation(s) in RCA: 2] [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 This study aims to identify the feasibility of uniportal video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) compared with multiportal VATS in the resection of mediastinal lesions. Methods Patients who underwent mediastinal lesion resection were enrolled and allocated to the uni-VATS, tri-VATS, and RATS groups according to the surgical approach. Propensity score-matched (PSM) analysis was performed between the VATS and RATS groups as well as the uni-VATS and tri-VATS groups. The operative and recovery parameters were compared. Results Totally, 274 patients were enrolled. There was no difference in the operative parameters among the groups. Compared with multiportal VATS, uniportal VATS and RATS had a significantly shorter chest tube placement time (2.43±0.88 vs. 1.78±1.22 vs. 2.21±1.11 days, P<0.001) and hospital length of stay (LOS) (4.07±1.75 vs. 3.27±1.05 vs. 3.62±1.21 days, P=0.001) without increasing the incidence rate of complications (5.6% vs. 7.2% vs. 5.7%, P=0.864). After PSM, the RATS group showed a significantly lower unplanned conversion rate than the VATS group (0.0% vs. 8.2%, P=0.041), while the uni-VATS group had a shorter chest tube placement time (1.83±1.20 vs. 2.35±0.86 days, P=0.013) and hospital LOS (3.23±1.03 vs. 3.95±2.00 days) than the tri-VATS group. Conclusions Compared with multiportal VATS, uniportal VATS and RATS are technically safe and feasible with potential advantages for mediastinal lesion resection.
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Affiliation(s)
- Liping Zeng
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weidong Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jia Han
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Linhai Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiangang Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhengliang Tu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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26
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Weng W, Li X, Meng S, Liu X, Peng P, Wang Z, Li J, Wang J. Video-assisted thoracoscopic thymectomy is feasible for large thymomas: a propensity-matched comparison. Interact Cardiovasc Thorac Surg 2020; 30:565-572. [PMID: 31990355 DOI: 10.1093/icvts/ivz320] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Video-assisted thoracoscopic thymectomy is becoming the preferable approach for early-stage thymoma. However, large thymomas are still recognized as a relative contraindication due to the possible risk of incomplete resection or capsular disruption. Thus, the aim of this study is to evaluate the feasibility of video-assisted thoracoscopic thymectomy for large thymomas. METHODS Patients diagnosed with Masaoka stage I-IV thymoma between April 2001 and December 2018 were retrospectively reviewed. All patients were divided into 2 groups: thymoma <5.0 cm (group A) and thymoma ≥5.0 cm (group B). Propensity score matching analysis was performed to compare postoperative results. Recurrence-free survival and overall survival were compared for oncological evaluation. RESULTS A total of 346 patients were included in this study. In the propensity score matching analysis, 126 patients were included both in group A and group B. There was no significant difference between these 2 groups in terms of the R0 resection rate (95.2% vs 94.4%, P = 1.000), conversion rate (1.6% vs 3.2%, P = 0.684), operation time (119.4 ± 48.4 vs 139.1 ± 46.6 min, P = 0.955), blood loss (93.2 ± 231.7 vs 100.5 ± 149.3 ml, P = 0.649), duration of chest drainage (2.7 ± 1.6 vs 2.8 ± 2.0 days, P = 0.184), length of hospitalization (5.0 ± 3.9 vs 5.2 ± 2.9 days, P = 0.628) or postoperative complications (5.9% vs 8.5%, P = 0.068). There was no significant difference between these 2 groups in terms of the overall survival (P = 0.271) and recurrence-free survival (P = 0.288). CONCLUSIONS Video-assisted thoracoscopic thymectomy is a safe and effective approach for large thymomas (≥5 cm) with comparable surgical and oncological results.
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Affiliation(s)
- Wenhan Weng
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Xiao Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Shushi Meng
- Peking University Health Science Center, Beijing, China
| | - Xianping Liu
- Peking University Health Science Center, Beijing, China
| | - Peng Peng
- Peking University Health Science Center, Beijing, China
| | - Zhenfan Wang
- Peking University Health Science Center, Beijing, China
| | - Jianfeng Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
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Mao Y, Lan Y, Cui F, Deng H, Zhang Y, Wu X, Liang W, Liu J, Liang H, He J. Comparison of different surgical approaches for anterior mediastinal tumor. J Thorac Dis 2020; 12:5430-5439. [PMID: 33209376 PMCID: PMC7656433 DOI: 10.21037/jtd-20-266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Different video-assisted thoracoscopic surgery (VATS) approaches may related to heterogeneous clinical outcomes in anterior mediastinal tumor surgery. Herein, we assessed the comparison between the subxiphoid and intercostal approach, and also compare the left versus the right incision in the intercostal approach for anterior mediastinal tumor patients. Methods Clinical data of patients receiving thoracoscopic anterior mediastinal tumor resection were retrospectively collected. Patients were divided into two groups according to the approaches: subxiphoid and the intercostal group. The intercostal group was further subdivided into two groups according to different sides: left and right incision group. Intraoperative and postoperative variables were compared between subgroups. Results A total of 238 patients were consecutively included in this analysis; 198 (83.2%) patients received intercostal procedure and 40 (16.8%) patients received subxiphoid approach. After 1:1 propensity score matching, all baseline characters were well balanced between intercostal and subxiphoid approach, left and right intercostal approach. The visual analogue scale (VAS) pain score was lower in patients underwent subxiphoid approach than intercostal group at first post-operative evaluation in 12–24 h (4.36 vs. 2.23; P=0.03). According to left and right approach, postoperative drainage time (1.9 vs. 1.2 days, P=0.016), postoperative drainage volume (312.1 vs. 193.9 mL, P=0.041) and hospitalization time (5.3 vs. 4.1 days, P=0.043) were significantly increased in the left thoracic approach group compared with the right thoracic approach. Conclusions Subxiphoid approach is associated with less pain compared with intercostal approach. The right intercostal thoracic approach may offer better clinical effect of short-term postoperative recovery.
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Affiliation(s)
- Yong Mao
- Department of Cardiothoracic Surgery, Ningbo First Hospital, Ningbo, China
| | - Yuting Lan
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.,Mental Health College, Guangzhou Medical University, Guangzhou, China
| | - Fei Cui
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Hongsheng Deng
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yaoliang Zhang
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xi Wu
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
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28
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Pupovac SS, Newman J, Lee PC, Alexis M, Jurado J, Hyman K, Glassman L, Zeltsman D. Intermediate oncologic outcomes after uniportal video-assisted thoracoscopic thymectomy for early-stage thymoma. J Thorac Dis 2020; 12:4025-4032. [PMID: 32944314 PMCID: PMC7475555 DOI: 10.21037/jtd-20-1370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Recent years have seen a trend towards utilizing a video-assisted thoracic surgery (VATS) approach for treatment of thymoma. Although increasing in practice, intermediate- and long-term oncologic outcome data is lacking for the VATS approach. There is no oncologic data for the uniportal VATS approach. We sought to evaluate the feasibility and impact on patient survival of uniportal VATS thymectomy for early-stage thymoma. Method The clinical outcomes for 17 patients with Masaoka stage I to II thymomas treated between January of 2009 and July of 2014 at a single institution were collected retrospectively. Primary endpoint was overall survival (OS) and secondary endpoint was recurrence-free survival (RFS). Results Ten women and seven men underwent uniportal VATS thymectomy; eleven had stage I thymoma and six had stage II thymoma. There were no conversions to open surgery. Operative mortality was zero. Mean tumor size was 3.8±1.0 centimeters, with a range of 1.9 to 6.0 centimeters. All patients underwent a R0 resection. Five-year survival was 100%, and the estimated RFS was 100%. Conclusions Our findings suggest that uniportal VATS thymectomy for early-stage thymoma is feasible, and the intermediate-term oncologic outcomes are comparable to historic standards for open and multi-incision VATS thymectomy. However, additional follow-up is required to evaluate for long-term oncologic outcomes.
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Affiliation(s)
- Stevan S Pupovac
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Joshua Newman
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Paul C Lee
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Miguel Alexis
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Julissa Jurado
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Kevin Hyman
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Lawrence Glassman
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - David Zeltsman
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, NY, USA
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Kumar A, Asaf BB, Pulle MV, Puri HV, Bishnoi S, Gopinath SK. Minimal Access Surgery for Thymoma. Indian J Surg Oncol 2020; 11:625-632. [PMID: 33281403 DOI: 10.1007/s13193-020-01208-1] [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: 03/30/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022] Open
Abstract
Thymoma is a rare epithelial tumor of the thymus gland. Despite rarity, it is the most common tumor of the anterior mediastinum. Surgical resection in the form of extended thymectomy is the gold standard operation. Conventionally and even in the current era of significant advances in the minimally invasive surgery, open transsternal extended thymectomy is considered the gold standard, particularly for advanced-stage tumors. There is however significant evidence now available for the use of minimally invasive approaches for early-stage thymomas. This article aims to discuss the various minimally invasive approaches currently being employed for thymomas.
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Affiliation(s)
- Arvind Kumar
- Department of Thoracic Surgery and Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Belal Bin Asaf
- Department of Thoracic Surgery & Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Mohan Venkatesh Pulle
- Department of Thoracic Surgery & Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Harsh Vardhan Puri
- Department of Thoracic Surgery & Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Sukhram Bishnoi
- Department of Thoracic Surgery & Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Srinivas Kodaganur Gopinath
- DNB Thoracic Surgery, Department of Thoracic Surgery and Director, Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Kemper M, Moradzadeh M, Bellon E, Bahar AS, Grotelüschen R, Reeh M, Izbicki JR, Bachmann K. A single-center experience: management of patients with thymic epithelial tumors. World J Surg Oncol 2020; 18:202. [PMID: 32791986 PMCID: PMC7427055 DOI: 10.1186/s12957-020-01988-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/04/2020] [Indexed: 01/23/2023] Open
Abstract
Background Thymic epithelial tumors are rare neoplasias. There are no internationally accepted standards to treat this complex oncological disease. The studies on which our knowledge is based frequently have methodological weaknesses. If the tumor is resectable, complete surgical excision is currently the first-line therapy. Thymic epithelial tumors respond to radiation. The therapeutic benefit of adjuvant radiotherapy depends on tumor stage. To validate and improve treatment, we share our current experiences with clinical management and surgical intervention. Methods This single-center retrospective study included 40 patients with primarily resectable thymic epithelial tumors who underwent resection with curative intent. The survival data was collected and presented according to Kaplan-Meier. Single- and multiple predictor survival analyses were carried out using the log-rank test and Cox proportional hazards model. Results Single-predictor survival analysis showed survival to be dependent on the Masaoka-Koga classification, WHO histological classification, resection status, surgical technique, and Clavien-Dindo grade for postoperative complications. Multiple predictor analysis confirms that the Masaoka-Koga stage (HR = 4.876, P = 0.032) and Clavien-Dindo grade (HR = 4.904, P = 0.011) are independent prognostic factors for survival. Conclusion In addition to the Masaoka stage, the occurrence of severe postoperative complications represents an independent prognostic factor. Given the tumor’s sensitivity to radiation, the use of neoadjuvant radiotherapy can be considered to downstage Masaoka-Koga stages III and higher, thus reducing surgical risks. Further prospective multicenter studies are urgently needed.
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Affiliation(s)
- Marius Kemper
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Mona Moradzadeh
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Eugen Bellon
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Ahmad S Bahar
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Rainer Grotelüschen
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Matthias Reeh
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Li XK, Xu Y, Cong ZZ, Zhou H, Wu WJ, Shen Y. Comparison of the progression-free survival between robot-assisted thymectomy and video-assisted thymectomy for thymic epithelial tumors: a propensity score matching study. J Thorac Dis 2020; 12:4033-4043. [PMID: 32944315 PMCID: PMC7475562 DOI: 10.21037/jtd-20-1065] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Robotic system was recently introduced to assist surgeons in performing thymectomy. However, whether robot-assisted thoracoscopic thymectomy (RATT) could replace video-assisted thoracoscopic thymectomy (VATT) and be considered as a superior treatment for thymic epithelial tumors is still controversial. The aim of this study was to evaluate the progression-free survival (PFS) and short-term clinical outcomes in patients undergoing RATT or VATT by comparing the matched two groups after performing propensity score analysis. Methods We retrospectively reviewed the clinical data of 295 patients diagnosed with thymic epithelial tumors. There were 60 patients in RATT group and 235 in VATT group. Propensity score matching was done between two groups with variables of age, gender, tumor size, organization histologic classification, original Masaoka stages, presence of myasthenia gravis (MG) and adjuvant therapy. Sixty patients from the RATT group and 60 from the VATT group were matched, fitting the model. The PFS and short-term clinical outcomes of matched groups were compared. Results After matching, the surgical time in RATT groups was significant shorter than that in VATT groups (P=0.042). Loco-regional recurrence and distal metastasis were detected in 4 patients with thymoma and 1 patient with thymic carcinoma in RATT group and in 25 patients with thymoma and 3 patients with thymic carcinoma in VATT group before matching. PFS were estimated in only thymoma cases. The PFS in RATT group (n=55) intended to be longer than that in VATT group (n=58) after matching (5-year PFS rate: 81.5% and 75.4%, respectively; log-rank P=0.095). Conclusions RATT has the superiorities over VATT on short-term outcomes due to enabling surgeons to operate in a stable and comfortable environment. Meanwhile, RATT yielded a longer PFS compared with VATT, although the difference was not significant. Therefore, RATT could be considered as a standard approach for the treatment of thymic epithelial tumors.
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Affiliation(s)
- Xiao-Kun Li
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yang Xu
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Zhuang-Zhuang Cong
- Department of Cardiothoracic Surgery, Jingling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hai Zhou
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Wen-Jie Wu
- Department of Clinical Medicine, School of Medicine, Southeast University, Nanjing, China
| | - Yi Shen
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Medicine, Southeast University, Nanjing, China.,Department of Cardiothoracic Surgery, Jingling Hospital, Medical School of Nanjing University, Nanjing, China
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Melis E, Gallo E, di Martino S, Gallina FT, Laquintana V, Casini B, Visca P, Ganci F, Alessandrini G, Caterino M, Cecere FL, Mandoj C, Papadantonakis A, De Bello N, Lattanzio R, Palmieri G, Garassino MC, Girard N, Conti L, Blandino G, Fazi F, Facciolo F, Pescarmona E, Ciliberto G, Marino M. Thymic Epithelial Tumors as a Model of Networking: Development of a Synergistic Strategy for Clinical and Translational Research Purposes. Front Oncol 2020; 10:922. [PMID: 32760665 PMCID: PMC7372300 DOI: 10.3389/fonc.2020.00922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/11/2020] [Indexed: 12/23/2022] Open
Abstract
Among the group of thymic epithelial tumors (TET), thymomas often show either uncertain or explicit malignant biological behavior, local invasiveness, and intrathoracic relapse and are often difficult to manage. From the initial stages, thymic carcinomas tend to show aggressive behavior and extrathoracic spread. Moreover, the interplay of epithelial cells and thymocytes in thymomas causes complex immune derangement and related systemic autoimmune diseases. Due to their rare occurrence and to the limited funding opportunities available for rare tumors, it is challenging to make advances in clinical and translational research in TET. The authors of this paper are all members of a multidisciplinary clinical and research thoracic tumor team. Strong input was given to the team by long-standing expertise in TET in the Pathology Department. In addition, thanks to the collaboration between research units at our Institute as well as to national collaborations, over the last 10 years we were able to perform several tissue-based research studies. The most recent studies focused on microRNA and on functional studies on the thymic carcinoma cell line 1889c. The recent implementation of our biobank now provides us with a new tool for networking collaborative research activities. Moreover, the participation in a worldwide community such as ITMIG (International Thymic Malignancy Interest Group) has allowed us to significantly contribute toward fundamental projects/research both in tissue-based studies (The Cancer Genome Atlas) and in clinical studies (TNM staging of TET). Our achievements derive from constant commitment and long-standing experience in diagnosis and research in TET. New perspectives opened up due to the establishment of national [the Italian Collaborative Group for ThYmic MalignanciEs (TYME)] and European reference networks such as EURACAN, for an empowered joint clinical action in adult solid rare tumors. The challenge we face still lies in the advancement of clinical and basic science in thymic epithelial malignancies.
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Affiliation(s)
- Enrico Melis
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Enzo Gallo
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Simona di Martino
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Valentina Laquintana
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Beatrice Casini
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Visca
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federica Ganci
- Oncogenomic and Epigenetic Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Mauro Caterino
- Radiology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Chiara Mandoj
- Clinical Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Nicoletta De Bello
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Rossano Lattanzio
- University “G. d'Annunzio,” Department of Medical, Oral and Biotechnological Sciences, Center for Advanced Studies and Technology (CAST), Chieti, Italy
| | - Giovannella Palmieri
- Scientific Direction, Department of Clinical Medicine and Surgery, Rare Tumors Reference Center, University Federico II, Naples, Italy
| | - Marina Chiara Garassino
- Thoracic Oncology Unit, Division of Medical Oncology, Foundation IRCCS–Italian National Cancer Institute, Milan, Italy
| | - Nicolas Girard
- Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France
| | - Laura Conti
- Clinical Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Blandino
- Oncogenomic and Epigenetic Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Fazi
- Department of Anatomical, Histological, Forensic & Orthopedic Sciences, Section of Histology & Medical Embryology, Sapienza University of Rome, Laboratory Affiliated to Instituto Pasteur Italia-Fondazione Cenci Bolognetti, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Edoardo Pescarmona
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Mirella Marino
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Robotic surgery vs. open surgery for thymectomy, a retrospective case-match study. J Robot Surg 2020; 15:375-379. [PMID: 32632562 DOI: 10.1007/s11701-020-01109-z] [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] [Received: 03/31/2020] [Accepted: 06/22/2020] [Indexed: 10/23/2022]
Abstract
The robotic approach in the treatment of thymus diseases has been described in many papers, but few studies have compared the early outcome of patients after robotic and open transsternal procedure. Our study aims to confirm the non-inferiority of the robotic technique in terms of feasibility, safety and postoperative patient recovery compared to the open standard. This is a retrospective cohort study in which we compare 114 patients who underwent thymectomy for a thymus disease at our thoracic surgery unit. Our robotic surgery programme started in February 2012 with the treatment of mediastinal diseases. Since then, we have performed 57 robotic thymectomies (Group A). This series was compared with 57 patients who underwent open thymectomies (Group B) performed before 2012, and all were properly matched through a propensity score. Hospital and ICU stay, postoperative pain, use of painkillers, operative time and complications rate were analysed. Postoperative pain, evaluated through the Visual Analogue Scale (VAS), was significantly lower in the robotic surgery group (p < 0.001), which was associated with a trend to lower use of painkillers in Group A, although it was not significant (p = 0.06). No statistical differences were observed between the two groups in terms of ICU stay (p = 0.080), although the total hospital stay was significantly longer in Group B (p = 0.003). No statistical differences were observed in operative time (p = 0.492) and complications rate (p = 0.950). The robotic-assisted technique showed the same operative time and complications rate compared with open surgery, thereby confirming its safety and feasibility in myasthenic patients as well as in Masaoka I-II thymomas. The lower postoperative pain and the shorter hospital stay associated with prompt mobilisation and faster chest drainage removal showed the great advantage of the minimally invasive robotic approach in these patients.
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Imielski B, Kurihara C, Manerikar A, Chaudhary S, Kosterski S, Odell D, Kim S, Bharat A. Comparative effectiveness and cost-efficiency of surgical approaches for thymectomy. Surgery 2020; 168:737-742. [PMID: 32641277 DOI: 10.1016/j.surg.2020.04.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND We compared the clinical outcomes and cost-efficiency of surgical approaches (sternotomy-open, video assisted thoracoscopic surgery, and robotic assisted thoracic surgery) for thymectomy. METHODS This is a retrospective review of 220 consecutive patients who underwent thymectomy between January 1, 2007, and January 31, 2017. Surgical approach was determined by the surgeon, but we only included cases that could be resected using any of the 3 approaches. RESULTS Open approach was used in 69 patients, whereas minimally invasive technique was used in 151 (97, video assisted thoracoscopic surgery; 54, robotic assisted thoracic surgery). Open surgery was associated with greater total hospital cost ($22,847 ± $20,061 vs $14,504 ± $10,845, P < .001). Open group also revealed longer duration of intensive care unit (1.2 ± 2.8 vs 0.2 ± 1.3 days, P < .001) and hospital stay (4.3 ± 4.0 vs 2.0 ± 2.6 days, P < .001). There were no differences in major adverse clinical outcomes. Long-term recurrence-free survival after resection of thymoma was similar between the groups. CONCLUSION Minimally invasive techniques were equally efficacious compared with the open approach in the resection of the thymus. Additionally, their use was associated with decreased hospital duration of stay and reduced cost. Hence the use of minimally invasive approaches should be encouraged in the resection of thymus.
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Affiliation(s)
- Bartlomiej Imielski
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Chitaru Kurihara
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Adwaiy Manerikar
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Satya Chaudhary
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Susan Kosterski
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - David Odell
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Samuel Kim
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Ankit Bharat
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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Video-assisted thoracoscopic surgery is safe and reliable for large and invasive primary mediastinal tumors. Wideochir Inne Tech Maloinwazyjne 2020; 16:163-168. [PMID: 33786130 PMCID: PMC7991948 DOI: 10.5114/wiitm.2020.94528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/22/2020] [Indexed: 11/17/2022] Open
Abstract
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 1 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. 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. Conclusions VATS is a safe and effective procedure for large and invasive mediastinal tumors.
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Rusidanmu A, Feng M, Xu J, Wang L, He C, Hu J. Trans-sternotomy versus video-assisted thoracic surgery for early-stage thymoma patients: a meta-analysis. Gland Surg 2020; 9:342-351. [PMID: 32420258 PMCID: PMC7225494 DOI: 10.21037/gs.2020.03.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 02/14/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Over the years, video-assisted thoracic surgery (VATS) thymectomy has progressively replaced trans-sternotomy (TS) in early-stage thymoma (Masaoka stage I and stage II). This meta-analysis aimed to confirm the differences in the efficacies of VATS and TS approaches in early-stage thymoma patients. METHODS A thorough literature search of the following online databases was performed: PubMed, Cochrane Library, Web of Science, and EMBASE. Appropriate search terms, such as "thymoma or thymus neoplasms or Thymic Carcinoma" and "Video-Assisted Thoracic Surgeries or Video-Assisted Thoracoscopic", were used with MeSH search methods. Heterogeneity was assessed first with the Q-test and inconsistency index and sensitivity analysis and subgroup analysis were then used to find the source of heterogeneity. RESULTS We retrieved 1,228 articles, 11 articles were selected as the subjects of our research, and 1,222 patients were included in the research (666 VATS cases versus 556 TS cases). VATS caused less blood loss (P=0.02), and required shorter hospital stay (P<0.001), shorter duration of chest tube drainage (P=0.03) than TS. No obvious difference was found in operative time (P=0.14), postoperative recurrence (OR =0.81, 95% CI: 0.35-1.85, P=0.613), postoperative complications (OR =0.60, 95% CI: 0.31-1.16, P=0.129) and R0 resection (OR =0.35, 95% CI: 0.12-1.04, P=0.06), but the trend showed that more patients in the TS group achieved R0 resection. CONCLUSIONS For early-stage thymoma patients, VATS thymectomy seems to provide many advantages to be considered as a legitimate alternative to TS; however, when performing VATS, surgeons should pay special attention to ensure that R0 resection is achieved.
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Affiliation(s)
- Aizemaiti Rusidanmu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Mingyang Feng
- Zhejiang university school of Medicine, Hangzhou 310029, China
| | - Jinming Xu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Luming Wang
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Cheng He
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jian Hu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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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: 36] [Impact Index Per Article: 7.2] [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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Wang GW, Tao T, Li CK, Li QC, Duan GX, Sang HW, Dong HJ, Wang ZY. Comparison between thoracoscopic and open approaches in thymoma resection. J Thorac Dis 2019; 11:4159-4168. [PMID: 31737299 DOI: 10.21037/jtd.2019.09.85] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To investigate the feasibility and indications of video-assisted thoracic surgery (VATS) in thymoma resection. Methods The clinical data of 103 patients undergoing thymoma resection via different approaches [including conventional lateral thoracotomy approach (LTA) in 41 cases, median sternotomy approach (MSA) in 40 cases, and right-sided VATS in 22 cases] were analyzed. Among them, 59, 13, 25, and 6 patients were in Masaoka stage I, II, III, and IV, respectively. Myasthenia gravis (MG) was also found in 54 cases. The patients were followed up for postoperative survival and the improvement in MG. The prognostic indicators of patients undergoing thymoma resection via different surgical approaches (i.e., LTA, MSA, and VATS) were statistically analyzed. Results Eight of 103 patients died. Six patients underwent unilateral sacral nerve resection, among whom 4 patients developed respiratory dysfunction, and 3 died. Two patients died of MG after surgery, 1 patient died of tumor recurrence and metastasis, 1 patient died of heart disease, and the cause of death was unknown in the remaining patient. The drainage time was shorter in VATS group than in open groups, along with smaller tumor size. The VATS group also had shorter hospital stay in the whole series and the subgroup without accompanying MG. The improvement in MG showed no significant difference among the three surgical groups. Both 5- and 10-year survival rates were 91% in the entire cohort. Conclusions VATS is like a conventional surgeries for improving MG in thymoma patients with accompanying MG. VATS resection can still be considered for thymoma that only invades the mediastinal pleura. For thymomas that have intact capsules and have not invaded mediastinal pleura, MSA surgery shall be performed to ensure patient safety if the anteroposterior diameters of the tumors are large and the masses have produced severe compression of the innominate vein, even if the tumors are still in the Masaoka stage II. For thymomas with large left-to-right diameters and with most parts of the tumors located in the left thoracic cavity, a left-sided approach (either VATS or an open approach) may be used in the absence of MG; if MG accompanies the condition, an MT approach or a bilateral VATS may be considered. In patients with unilateral pericardial phrenic nerve and/or local pericardial involvement, right-sided VATS thymectomy may be considered for thymomas located at the right side and bilateral VATS surgery can be performed for tumors located at the left side. In summary, VATS is feasible for the treatment of thymoma complicated by MG. VATS can be performed in patients with Masaoka stage I, II and (a certain portion of) III thymoma; for some patients with Masaoka stage II thymoma, especially those with compression of the innominate vein, the use of VATS should be cautious.
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Affiliation(s)
- Guo-Wen Wang
- Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Tao Tao
- Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Chuan-Kui Li
- Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Qi-Cai Li
- Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Gui-Xin Duan
- Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Hai-Wei Sang
- Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Hai-Jun Dong
- Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Zu-Yi Wang
- Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
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Khanh HQ, Quang NVD, Tien TQ, Vuong NL. Long-term oncological outcome in thymic malignancies: videothoracoscopic versus open thymectomy. Eur Surg 2019. [DOI: 10.1007/s10353-019-00610-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Burt BM, Nguyen D, Groth SS, Palivela N, Ripley RT, Makris KI, Farjah F, Cornwell L, Massarweh NN. Utilization of Minimally Invasive Thymectomy and Margin-Negative Resection for Early-Stage Thymoma. Ann Thorac Surg 2019; 108:405-411. [DOI: 10.1016/j.athoracsur.2019.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 01/11/2023]
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Gu Z, Chen C, Wang Y, Wei Y, Fu J, Zhang P, Liu Y, Zhang R, Chen K, Yu Z, Pang L, Liu Y, Li Y, Han Y, Chen H, Zhou X, Cui Y, Tan L, Ding J, Shen Y, Liu Y, Fang W. Video-assisted thoracoscopic surgery versus open surgery for Stage I thymic epithelial tumours: a propensity score-matched study. Eur J Cardiothorac Surg 2019; 54:1037-1044. [PMID: 30016438 DOI: 10.1093/ejcts/ezy239] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 05/31/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Video-assisted thoracoscopic surgery (VATS) has been increasingly used in the management of thymic epithelial tumours. However, its oncological efficacy remains to be proved. The purpose of this study is to compare the oncological outcomes following thoracoscopic versus open surgery in the case-matched groups of patients with early-stage thymic tumours from the Chinese Alliance for Research in Thymomas (ChART) retrospective database. METHODS Between 1994 and 2012, a total of 1087 patients who underwent surgery for UICC (Union for International Cancer Control) pathological Stage I tumours from the ChART retrospective database were recruited for this study. A propensity score-matched analysis was used to compare the long-term outcomes in patients who received VATS or open surgery. RESULTS VATS resection was performed in 271 patients (24.9%) and open surgery in 816 patients (75.1%). Before propensity score matching, the VATS group had a smaller tumour size (P = 0.002), lower grade histology (P = 0.034), lower T stage (P < 0.001) and less adjuvant therapy (P < 0.001). Propensity score matching by gender, myasthenia gravis, tumour size, histological classification, pathological T stage, extent of thymectomy, adjuvant radiotherapy and adjuvant chemotherapy identified 110 patients in each group. After matching, there was no significant difference in patient demographics, tumour characteristics or adjuvant therapy. All matched patients had R0 resection. Overall survival, disease-free survival and cumulative incidence of recurrence were only predicted by WHO histology, but not by surgical approach, in both univariable and multivariable analyses. There was no significant difference in the overall survival (85.7% vs 93.1%, P = 0.539), disease-free survival (92.5% vs 91.9%, P = 0.773), cumulative incidence of recurrence (7.1% vs 5.8%, P = 0.522) and improvement rate of myasthenia gravis (83.3% vs 88.2%, P = 0.589) between the 2 groups. CONCLUSIONS This propensity score-matched study suggests that VATS and open surgeries are associated with similar oncological outcomes for Stage I thymic epithelial tumours. Minimally invasive surgery might be an acceptable surgical approach for early-stage thymic malignancies.
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Affiliation(s)
- Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yun Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yucheng Wei
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Peng Zhang
- Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang, China
| | - Renquan Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Keneng Chen
- Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China
| | - Liewen Pang
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yangchun Liu
- Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang, China
| | - Yin Li
- Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - Hezhong Chen
- Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai, China
| | - Xinming Zhou
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - Youbin Cui
- Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianyong Ding
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Shen
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuan Liu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Deng J, She Y, Zhao M, Ren Y, Zhang L, Su H, Yang M, Jiang G, Xie D, Chen C. Simultaneously thoracoscopic resection of lung cancer and anterior mediastinal lesions by video-assisted thoracoscopic surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:333. [PMID: 31475203 DOI: 10.21037/atm.2019.06.61] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Video-assisted thoracoscopic surgery (VATS) has been widely applied to various types of pulmonary and mediastinal resections in recent years. However, there are still limited experiences of simultaneous thoracoscopic resection for lung cancer and mediastinal tumor. The aim of the study is to investigate the technical safety and feasibility of uniportal VATS for simultaneous resection for concurrent diseases of lung and anterior mediastinum and to compare with multiportal VATS. Methods From June 2014 to December 2017, all patients who underwent simultaneously thoracoscopic resection for lung cancer and anterior mediastinal mass under uniportal or multiportal VATS via the same incision were retrospectively reviewed. Study cohort was divided according to surgical approach. Perioperative outcomes, including operative time, intraoperative blood loss, and postoperative hospitalization, were compared between uniportal and multiportal VATS groups. Results A total of 51 patients were included in the study, of whom 33 patients had uniportal VATS and 18 patients had multiportal VATS. When compared to multiportal VATS group, uniportal VATS group had similar time of operation (149.1±49.0 vs. 159.1±58.5, P=0.518), intraoperative blood loss (103.0±184.3 vs. 105.6±80.2, P=0.956), and postoperative length of hospital stay (4.7±2.0 vs. 5.5±3.0, P=0.246). No operative deaths occurred in this study. Conclusions Uniportal VATS for simultaneously thoracoscopic resection for lung cancer and anterior mediastinal disease is technically safe and feasible and has comparable operative parameters with multiportal VATS.
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Affiliation(s)
- Jiajun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Mengmeng Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Yijiu Ren
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Hang Su
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Minglei Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.,Department of Cardiothoracic Surgery, Ningbo No. 2 Hospital, Ningbo 315012, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
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Carretta A. Surgical treatment of invasive thymomas: which approach? J Thorac Dis 2019; 11:1076-1078. [PMID: 31179043 DOI: 10.21037/jtd.2019.02.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Angelo Carretta
- Department of Thoracic Surgery, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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Li F, Ismail M, Elsner A, Uluk D, Bauer G, Meisel A, Rueckert JC. Surgical Techniques for Myasthenia Gravis. Thorac Surg Clin 2019; 29:177-186. [DOI: 10.1016/j.thorsurg.2018.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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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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Van Backer JT, Cedeno-Rodriguez A, Nabagiez J. Third distant recurrence of benign thymoma in a patient with myasthenia gravis. BMJ Case Rep 2019; 12:12/4/e228529. [PMID: 30988107 DOI: 10.1136/bcr-2018-228529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Myasthenia gravis (MG) is an autoimmune disease where antibodies attack the presynaptic terminals at the neuromuscular junction causing progressive weakness. Associated with thymomas, resection can improve symptoms. A 29-year-old woman with MG who underwent two previous thymectomies, at ages 11 and 15 presented 14 years later with recurrent MG symptoms and an anterior mediastinal mass. Robotic-assisted thoracoscopic excision of the mediastinal mass was performed without complications. She recovered well and had improvement of her MG symptoms. Thymectomy can significantly improve symptoms in MG even for patients who do not have a thymoma. Reports of distant benign thymoma recurrence are rare. MG patients require continued monitoring and vigilance, even after thymectomy. Benign thymomas can recur even after significant time intervals, and utilisation of the robotic platform for recurrent thymoma excision is safe, even following two sternotomies. Patient symptoms improve with redo thymectomy.
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Affiliation(s)
| | | | - John Nabagiez
- Thoracic Surgery, Albany Medical Center Hospital, Albany, New York, USA
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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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Gross DJ, Zangbar B, Muthu N, Chang EH, Badami A, Stein L, Gruessner R, Poston R. Saving the split: the benefits of VATS thymectomy. J Thorac Dis 2019; 11:1428-1432. [PMID: 31179085 DOI: 10.21037/jtd.2019.03.51] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background With the advent of minimally invasive techniques, the standard approaches to many surgeries have changed. We compared the financial costs and health care outcomes between standard thymectomy via sternotomy and video assisted thoracoscopic surgery (VATS). Methods A 3-year review [2010-2012] of the National Inpatient Sample (NIS) was performed. All patients undergoing thymectomy were included. Patients undergoing VATS thymectomy were identified. Outcomes measured were hospital length of stay (LOS), hospital charges, and mortality. Univariate and multivariate analyses were performed to control for demographics and comorbidities. Results The results of 2,065 patients who underwent thymectomy were analyzed, of which 373 (18.1%) had VATS thymectomy and 1,692 (81.9%) had standard thymectomy. Mean age was 52.8±16, 42.5% were male, and 65.5% were Caucasian. There was a significant interval increase in number of patients undergoing VATS thymectomy (10% in 2010 vs. 19.2% in 2012, P<0.001). Patients undergoing standard thymectomy had longer hospital LOS (6.8±6.6 vs. 3.3d±3.4 d, P<0.001), hospital charges $88,838±$120,892 vs. $57,251±$54,929) and hospital mortality (0.9% vs. 0%, P=0.01). In multivariate analysis, thymectomy via sternotomy was independently associated with increased hospital LOS B =1.6 d, P<0.001) and charges (B = $13,041, P=0.041). Conclusions Our study demonstrates decreased hospital length of stay and reduced hospital charges in patients undergoing VATS thymectomy compared to standard thymectomy. Our data demonstrates that the prevalence of VATS thymectomies is increasing, likely related to improved healthcare and financial outcomes.
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Affiliation(s)
- Daniel J Gross
- Department of Surgery, State University of New York, Brooklyn University Hospital, Brooklyn, NY, USA
| | - Bardiya Zangbar
- Department of Surgery, State University of New York, Brooklyn University Hospital, Brooklyn, NY, USA
| | - Nagarajan Muthu
- Division of Acute Care Surgery, Department of Surgery, Kings County Medical Center, Brooklyn, NY, USA
| | - Erin H Chang
- Department of Surgery, State University of New York, Brooklyn University Hospital, Brooklyn, NY, USA
| | - Abbasali Badami
- Department of Surgery, State University of New York, Brooklyn University Hospital, Brooklyn, NY, USA
| | - Louis Stein
- Department of Surgery, State University of New York, Brooklyn University Hospital, Brooklyn, NY, USA
| | - Rainer Gruessner
- Department of Surgery, State University of New York, Brooklyn University Hospital, Brooklyn, NY, USA
| | - Robert Poston
- Department of Surgery, State University of New York, Brooklyn University Hospital, Brooklyn, NY, USA
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Abstract
Surgery has proven superiority over medical management for patients with nonthymomatous myasthenia gravis. The key is complete resection of the gland, which can be achieved with various techniques. The uniportal video-assisted transcervical technique allows minimally invasive surgery with a low complication rate, a good cosmetic result, and a short length of recovery.
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