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Yudai M, Takashi K, Hiroto I, Eriko F, Toru K, Naoko O, Soichiro F, Yasushi S. The role of calcification in predicting invasion of thymoma to adjacent organs. Surg Today 2024:10.1007/s00595-024-02826-w. [PMID: 38600335 DOI: 10.1007/s00595-024-02826-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/01/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE Thoracoscopic procedures such as video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) have gained popularity for the treatment of thymoma. Accurate preoperative assessments of tumor invasion are crucial to identifying the appropriate surgical approach. Although imaging techniques have been used to predict invasion, a quantifiable method is still needed in clinical practice. METHODS The ubjects of this retrospective study were 226 patients with thymoma who underwent surgery at our hospital. Clinicopathological data, tumor staging, and recurrence rates were analyzed. Calcification identified through computed tomography (CT) defined the "calcified group" as having a long diameter of ≥ 5 mm. Statistical analyses were performed to assess relationships and survival outcomes. RESULTS The calcified group had higher Masaoka and World Health Organization classification than the noncalcified group, with significantly higher organ invasion rates. The calcified group also had remarkably higher recurrence rates. CONCLUSION Thymoma calcification appears to correlate with increased invasiveness and recurrence rates, suggesting its potential as a predictor of tumor stage and prognosis. Despite its retrospective nature and inherent limitations, this study highlights the potential clinical significance of calcification in the surgical planning and prognostication of patients with thymoma.
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Affiliation(s)
- Miyashita Yudai
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kanou Takashi
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Ishida Hiroto
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Fukui Eriko
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kimura Toru
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ose Naoko
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Funaki Soichiro
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shintani Yasushi
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Taje R, Peer M, Gallina FT, Ambrogi V, Sharbel A, Melis E, Elia S, Idit M, Facciolo F, Patirelis A, Sorge R, Pompeo E. Ergonomic Assessment of Robotic versus Thoracoscopic Thymectomy. J Clin Med 2024; 13:1841. [PMID: 38610606 PMCID: PMC11012820 DOI: 10.3390/jcm13071841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
Introduction: Robotic and thoracoscopic surgery are being increasingly adopted as minimally invasive alternatives to open sternotomy for complete thymectomy. The superior maneuverability range and three-dimensional magnified vision are potential ergonomical advantages of robotic surgery. To compare the ergonomic characteristics of robotic versus thoracoscopic thymectomy, a previously developed scoring system based on impartial findings was employed. The relationship between ergonomic scores and perioperative endpoints was also analyzed. Methods: Perioperative data of patients undergoing robotic or thoracoscopic complete thymectomy between January 2014 and December 2022 at three institutions were retrospectively retrieved. Surgical procedures were divided into four standardized surgical steps: lower-horns, upper-horns, thymic veins and peri-thymic fat dissection. Three ergonomic domains including maneuverability, exposure and instrumentation were scored as excellent(score-3), satisfactory(score-2) and unsatisfactory(score-1) by three independent reviewers. Propensity score matching (2:1) was performed, including anterior mediastinal tumors only. The primary endpoint was the total maneuverability score. Secondary endpoints included the other ergonomic domain scores, intraoperative adverse events, conversion to sternotomy, operative time, post-operative complications and residual disease. Results: A total of 68 robotic and 34 thoracoscopic thymectomies were included after propensity score matching. The robotic group had a higher total maneuverability score (p = 0.039), particularly in the peri-thymic fat dissection (p = 0.003) and peri-thymic fat exposure score (p = 0.027). Moreover, the robotic group had lower intraoperative adverse events (p = 0.02). No differences were found in residual disease. Conclusions: Robotic thymectomy has shown better ergonomic maneuverability compared to thoracoscopy, leading to fewer intraoperative adverse events and comparable early oncological results.
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Affiliation(s)
- Riccardo Taje
- Department of Thoracic Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.T.); (V.A.); (A.P.)
- Doctoral School of Microbiology, Immunology, Infectious Diseases and Transplants, MIMIT, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Michael Peer
- Department of Thoracic Surgery, Ichilov Medical Center, Tel Aviv 6423906, Israel; (M.P.); (A.S.)
| | - Filippo Tommaso Gallina
- Department of Thoracic Surgery, IRCCS National Cancer Institute Regina Elena, 00144 Rome, Italy; (F.T.G.); (E.M.); (F.F.)
| | - Vincenzo Ambrogi
- Department of Thoracic Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.T.); (V.A.); (A.P.)
| | - Azzam Sharbel
- Department of Thoracic Surgery, Ichilov Medical Center, Tel Aviv 6423906, Israel; (M.P.); (A.S.)
| | - Enrico Melis
- Department of Thoracic Surgery, IRCCS National Cancer Institute Regina Elena, 00144 Rome, Italy; (F.T.G.); (E.M.); (F.F.)
| | - Stefano Elia
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy;
| | - Matot Idit
- Department of Anaesthesia and Intensive Care, Ichilov Medical Center, Tel Aviv 6423906, Israel;
| | - Francesco Facciolo
- Department of Thoracic Surgery, IRCCS National Cancer Institute Regina Elena, 00144 Rome, Italy; (F.T.G.); (E.M.); (F.F.)
| | - Alexandro Patirelis
- Department of Thoracic Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.T.); (V.A.); (A.P.)
| | - Roberto Sorge
- Department of Biostatistics, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Eugenio Pompeo
- Department of Thoracic Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.T.); (V.A.); (A.P.)
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Dang J, Sun S, Wu Z, Shan Y, Zhang H. Meta-analysis of clinical efficacy of thoracoscopy and robotic surgery in the treatment of mediastinal tumors. World J Surg Oncol 2024; 22:70. [PMID: 38413953 PMCID: PMC10900664 DOI: 10.1186/s12957-024-03325-5] [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: 11/20/2023] [Accepted: 01/23/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE Comparing the clinical efficacy of thoracoscopy and robotic surgery in the treatment of mediastinal tumors using meta-analysis. METHODS Computer retrieval of PubMed, Embase, The Cochrane Library, and Web of Science databases for literature comparing the clinical effects of video-assisted thoracic surgery (VATS) and robot-assisted thoracic surgery (RATS) in treating mediastinal tumors, with the retrieval time limit from the establishment of the database to September 2023. Two evaluators independently screened the literature, extracted data, and assessed the risk of bias. Meta-analysis was performed using RevMan 5.4. RESULTS A total of 19 articles were included, with a total of 3517 patients. The results of the Meta-analysis showed that the RATS group had less intraoperative bleeding [MD = - 5.20, 95%CI (- 9.28, - 1.12), P = 0.01], lower rate of conversion to thoracotomy [OR = 0.41, 95%CI (0.23, 0.72), P = 0.002], lower rate of total postoperative complications [OR = 0.57, 95%CI (0.34, 0.95), P = 0.03], shorter postoperative drainage time [MD = - 0.72, 95%CI (- 1.13, - 0.32), P = 0.0004], and shorter postoperative hospital stay [MD = - 0.90, 95%CI (- 1.16, - 0.65), P < 0.001], in comparison with the VATS group. There was an insignificant difference between the two groups in terms of tumor size [MD = - 0.02, 95%CI (- 0.33, 0.30), P = 0.91] and operation time [MD = 0.17, 95%CI (- 7.61, 7.94), P = 0.97]. However, in regards to hospitalization costs [MD = 2634.75, 95%CI (991.62, 4277.88), P = 0.002], the RATS group was more expensive than the VATS group. CONCLUSION Robot-assisted mediastinal tumor resection surgery has more advantages in terms of intraoperative bleeding, conversion to thoracotomy rate, total postoperative complication rate, postoperative drainage time, and postoperative hospital stay, in comparison with thoracoscopic-assisted mediastinal tumor resection surgery. There is an insignificant difference in tumor size and operation time between the two surgeries. However, robot-assisted mediastinal tumor resection surgery increases hospitalization costs.
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Affiliation(s)
| | - Shize Sun
- Wuwei Liangzhou Hospital, Gansu, China
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Chao YK, Lee JY, Lu HI, Tseng YL, Lee JM, Huang WC. Robot-assisted surgery outperforms video-assisted thoracoscopic surgery for anterior mediastinal disease: a multi-institutional study. J Robot Surg 2024; 18:21. [PMID: 38217569 DOI: 10.1007/s11701-023-01745-1] [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: 10/26/2023] [Accepted: 12/10/2023] [Indexed: 01/15/2024]
Abstract
Anterior mediastinal procedures are increasingly being performed using robot-assisted thoracic surgery (RATS) or video-assisted thoracoscopic surgery (VATS). While both approaches have shown superior outcomes compared to open surgery, their comparative benefits are not as distinct. The aim of this retrospective study was to bridge this knowledge gap using a multicenter dataset. Patients who underwent elective minimally invasive surgery for anterior mediastinal disease between 2015 and 2022 were deemed eligible. The study participants were grouped based on whether a robot was used or not, and perioperative outcomes were compared. To mitigate selection bias, inverse probability of treatment weighting (ITPW) was applied using the propensity score. The final analysis included 312 patients (RATS = 120; VATS = 192). Following the application of IPTW, RATS was found to be associated with a longer operating time (215.3 versus 139.31 min, P < 0.001), fewer days with a chest tube (1.96 versus 2.61 days, P = 0.047), and a shorter hospital stay (3.03 versus 3.91 days, P = 0.041) compared to VATS. Subgroup analyses indicated that the benefit of RATS in reducing the length of hospital stay was particularly pronounced in patients with tumors larger than 6 cm (mean difference [MD] = - 2.28 days, P = 0.033), those diagnosed with myasthenia gravis (MD = - 3.84 days, P = 0.002), and those who underwent a trans-subxiphoid surgical approach (MD = - 0.81 days, P = 0.04). Both VATS and RATS are safe and effective approaches for treating anterior mediastinal disease. However, RATS holds distinct advantages over VATS including shorter hospital stays and reduced chest tube drainage periods.
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Affiliation(s)
- Yin-Kai Chao
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, 5 Fuxing Street, Taoyuan, 333, Taiwan.
| | - Jui-Ying Lee
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Hung-I Lu
- Department of Cardiovascular and Thoracic Surgery, Chang Gung Memorial Hospital-Kaohsiung, Chang Gung University, Kaohsiung, Taiwan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Jang-Ming Lee
- Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Wen-Chien Huang
- Department of Thoracic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
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E H, Yang C, Zhang L, Xia L, Xu L, Song N, Hu X, Zhu Y, Chen C, Zhao D. Perioperative outcomes comparison of robotic and video-assisted thoracoscopic thymectomy for thymic epithelial tumor: a single-center experience. Updates Surg 2023:10.1007/s13304-023-01702-5. [PMID: 38060172 DOI: 10.1007/s13304-023-01702-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The advent of robot-assisted thoracoscopic surgery (RATS) has completely revolutionized the modality of thymectomy, which could reportedly achieve equivalent efficacy compared with a minimally invasive approach. This study was conducted to further compare the perioperative outcomes between these two modalities. METHODS A retrospective single-center study that included patients receiving either a robotic or video-assisted thoracoscopic (VAT) thymectomy between February 2021 and January 2023 was conducted. All the patients were pathologically confirmed with thymic epithelial tumors. Clinical and pathological characteristics and perioperative outcomes were collected and compared between these two cohorts. RESULTS A total of 190 patients were included in this study, with 61 (32.1%) and 129 (67.9%) receiving robotic and video-assisted thymectomy, respectively. The clinicopathological characteristics were not significantly different between these 2 groups. The size of the resected specimens in the RATS cohort was larger than the VATS cohort [median (IQR), 13.0 (8.0-16.0) vs. 9.0 (6.7-12.0) cm, p < 0.001], while the procedural duration was longer for the RATS group than its counterpart [median (IQR), 105 (85-143) vs. 85 (69-115) min, p = 0.001]. Moreover, no other significant difference was observed between these two groups. Since more than half of the robotic thymectomy was performed using a subxiphoid approach, a subgroup analysis was further conducted. Similarly, the robotic group through a subxiphoid approach harbored a longer procedural duration, and the size of the specimens obtained was larger than the VATS group [median (IQR), 14.0 (11.0-16.5) vs. 12.5 (8.5-15.0) cm, p = 0.061]. CONCLUSIONS The early clinical efficacy of robotic thymectomy was proven comparable to the established VATS approach, and such a modality might have strength when obtaining larger specimens, which could contribute to improving long-term efficacy. Despite the longer procedural duration recorded in the early stage of conducting robotic thymectomy, further accumulation would help decrease the time.
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Affiliation(s)
- Haoran E
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Chenlu Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Lang Xia
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Long Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Nan Song
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Xuefei Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China.
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Li G, Chang H, Wang Z, He D, Qu L, Shao Q, Wang Q. Effect of open versus video-assisted thoracoscopy on perioperative outcomes and survival for cases of thymic carcinomas and thymic neuroendocrine tumors. World J Surg Oncol 2023; 21:329. [PMID: 37845701 PMCID: PMC10578011 DOI: 10.1186/s12957-023-03210-7] [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: 02/09/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The oncology-related indices between open and video-assisted thoracoscopic surgery (VATS) procedures for thymic carcinomas (TCs) and thymic neuroendocrine tumors (TNETs) remain unclear. METHODS Propensity score matching (PSM) and multivariate Cox proportional risk models were used to evaluate the perioperative outcomes and survival rates of patients undergoing open and VATS for TCs and TNETs at the Second Affiliated Hospital of Air Force Military Medical University Hospital, between 2009 and 2018. RESULTS Of the total 126 cases of TCs and TNETs, VATS treatment was used in 39 (30.9%). Advanced age and Masaoka-Koga staging were found to be independent prognostic factors for both TCs and TNETs, through a multifactorial Cox regression analysis. There was no significant difference in survival between the VATS and open groups before and after PSM; however, the VATS group had better perioperative-related indicators. There were no significant differences between the groups in terms of mortality at 30 days, mortality at 90 days, R0 resection rate, and 5-year survival rate (67.5% vs. 58.5% [P = 0.260] in the VATS group compared to the open group, in a PSM analysis of the 27 VATS and 27 open groups). Compared to the open group, the VATS group had a shorter length of hospital stay (13 days vs. 16 days, P = 0.015), a shorter level I care (0 days vs. 1 day, P = 0.016), and less intraoperative bleeding (50 mL vs. 300 mL, P < 0.001). CONCLUSIONS In this single-center retrospective study of TCs and TNETs, survival rates were comparable between the VATS group and the open group, and the VATS group showed improved perioperative-related parameters.
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Affiliation(s)
- Gaiyan Li
- Department of Radiotherapy Oncology, Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Hao Chang
- Department of Radiotherapy Oncology, Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | | | - Dongjie He
- Department of Radiotherapy Oncology, Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Lin Qu
- Department of Thoracic Surgery, Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Qiuju Shao
- Department of Radiotherapy Oncology, Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Qiming Wang
- Department of Radiotherapy Oncology, Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China.
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7
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Xu C, Zhang Q, Li J, Qiu H, Zhu K, Chen D, Jin Z, Zhang J, Zhang B, Witharana P, Chen B, Xu E, Shen J. Prognosis and surgical outcomes of the total thymectomy versus thymomectomy in non-myasthenic patients with early-stage thymoma: A systematic review and meta-analysis. Asian J Surg 2023; 46:3455-3463. [PMID: 37005182 DOI: 10.1016/j.asjsur.2023.03.063] [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: 10/26/2022] [Revised: 12/21/2022] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
Whether thymectomy (TM) or thymomectomy (TMM) is better for non-myasthenic patients with early-stage thymoma. We conducted a meta-analysis to compare the clinical outcomes and prognoses of non-myasthenic patients with early-stage thymoma treated using thymectomy versus thymomectomy. PubMed, Embase, Cochrane Library and CNKI databases were systematically searched for relevant studies on the surgical treatment (TM and TMM) of non-myasthenic patients with early-stage thymoma published before March 2022. The Newcastle-Ottawa scale was used to evaluate the quality of the studies, and the data were analyzed using RevMan version 5.30. Fixed or random effect models were used for the meta-analysis depending on heterogeneity. Subgroup analyses were performed to compare short-term perioperative and long-term tumor outcomes. A total of 15 eligible studies, including 3023 patients, were identified in the electronic databases. Our analysis indicated that TMM patients might benefit from a shorter duration of surgery (p = 0.006), lower blood loss volume (p < 0.001), less postoperative drainage (p = 0.03), and a shorter hospital stay (p = 0.009). There were no significant differences in the overall survival rate (p = 0.47) or disease-free survival rate (p = 0.66) between the two surgery treatment groups. Likewise, TM and TMM were similar in the administration of adjuvant therapy (p = 0.29), resection completeness (p = 0.38), and postoperative thymoma recurrence (p = 0.99). Our study revealed that TMM might be a more appropriate option in treating non-myasthenic patients with early-stage thymoma.
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Affiliation(s)
- Congcong Xu
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Qipeng Zhang
- Department of Thoracic Surgery, General Hospital of Southern Theater Command, Guangzhou, 510010, Guangdong Province, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong Province, China
| | - Jiawei Li
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Hongbin Qiu
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Kanghao Zhu
- Department of Cardiothoracic Surgery, Taizhou Hospital, Zhejiang University, Linhai, 317000, Zhejiang Province, China
| | - Dong Chen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Zixian Jin
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Jian Zhang
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Bo Zhang
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Pasan Witharana
- Northern General Hospital, Herries Rd, Sheffield, S5 7AU, UK; Imperial College London, London, SW7 2BX, UK
| | - Baofu Chen
- Precision Medicine Center, Taizhou Central Hospital (Taizhou University Hospital), Department of Cardiothoracic Surgery, Taizhou, 318000, Zhejiang Province, China.
| | - Enwu Xu
- Department of Thoracic Surgery, General Hospital of Southern Theater Command, Guangzhou, 510010, Guangdong Province, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong Province, China.
| | - Jianfei Shen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China.
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Petroncini M, Solli P, Brandolini J, Lai G, Antonacci F, Garelli E, Kawamukai K, Forti Parri SN, Bonfanti B, Dolci G, Bertoglio P. Early Postoperative Results after Thymectomy for Thymic Cancer: A Single-Institution Experience. World J Surg 2023; 47:1978-1985. [PMID: 37079104 PMCID: PMC10310559 DOI: 10.1007/s00268-023-06996-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Surgery for thymic cancers is considered the key of curative treatment. Preoperative patients' characteristics and intraoperative features might influence postoperative outcome. We aim to verify short-term outcomes and possible risk factors for complications after thymectomy. METHODS We retrospectively investigated patients undergoing surgery for thymoma or thymic carcinoma in the period between January 1, 2008, and December 31, 2021, in our department. Preoperative features, surgical technique (open, bilateral VATS, RATS), intraoperative characteristics and incidence of postoperative complications (PC) were analyzed. RESULTS We included in the study 138 patients. Open surgery was performed in 76 patients (55.1%), in 36 VATS (26.1%) and in 26 RATS (36.1%). Resection of one or more adjacent organs due to neoplastic infiltration was required in 25 patients. PC appeared in 25 patients (52% Clavien-Dindo grade I, 12% grade IVa). Open surgery had a higher incidence of PC (p < 0.001), longer postoperative in-hospital stay (p = 0.045) and larger neoplasm (p = 0.006). PC were significant related to pulmonary resection (p = 0.006), phrenic nerve resection (p = 0.029), resection of more than one organ (p = 0.009) and open surgery (p = 0.001), but only extended surgery of more organs was confirmed as independent prognostic factor for PC (p = 0.0013). Patients with preoperative myasthenia symptoms have a trend toward stage IVa complications (p = 0.065). No differences were observed between outcomes of VATS and RATS. CONCLUSIONS Extended resections are related to a higher incidence of PC, while VATS and RATS guarantee a lower incidence of PC and shorter postoperative stay even in patients that require extended resections. Symptomatic myasthenia patients might have a higher risk toward more severe complications.
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Affiliation(s)
- Matteo Petroncini
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Piergiorgio Solli
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Jury Brandolini
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Giulia Lai
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Filippo Antonacci
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Elena Garelli
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Kenji Kawamukai
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Sergio Nicola Forti Parri
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Barbara Bonfanti
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Giampiero Dolci
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy.
- Alma Mater Studiorum, Università di Bologna, Bologna, Italy.
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Lau J, Ioan Cvasciuc T, Simpson D, C de Jong M, Parameswaran R. Continuing challenges of primary neuroendocrine tumours of the thymus: A concisereview. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:2360-2368. [PMID: 35922282 DOI: 10.1016/j.ejso.2022.07.017] [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: 01/19/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 12/14/2022]
Abstract
Primary neuroendocrine tumours of the thymus (NETTs) are exceedingly rare tumours, usually presenting around mid-life, which have a propensity towards males and smokers. They are seen more often in those with MEN-1, but multiple different genetic mutations have been found to be involved in the tumorigenesis of NETTs. Histologically, NETTs are classified according to number of mitoses, the presence of necrosis, and the presence or absence of small cell features. NETTs display a wide spectrum of behavior, and they can be incidentally found on chest imaging, on screening in MEN-1, or present with symptoms of local compression. Advanced disease and paraneoplastic syndromes are common. CT-, PET/CT-, MRI-scans, and somatostatin receptor scintigraphy are the imaging modalities of choice both for the initial assessment as well as for monitoring after treatment. For patients with localized disease, complete surgical resection with lymphadenectomy provides the best chance of long-term, disease-free survival, and can be achieved through either an open or thoracoscopic approach. While chemotherapy-regimens based on platinum, taxane, and temozolomide are used most often, the optimum chemotherapy regimen in the adjuvant and palliative settings remains unclear, as does the role of radiotherapy. Ongoing research on the most effective use of somatostatin analogues, peptide receptor radionuclide therapy (PPRT), kinase inhibitors and immunotherapy in patients with other types of advanced neuroendocrine tumours may lead to further treatment options for NETTs in the future.
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Affiliation(s)
- Joel Lau
- Division of Endocrine Surgery, National University Health System, 119074, Singapore
| | - Titus Ioan Cvasciuc
- Division of Endocrine Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, 274 Grosvenor Rd, Belfast, BT12 6BA, UK
| | - Duncan Simpson
- Division of Endocrine Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, 274 Grosvenor Rd, Belfast, BT12 6BA, UK
| | - Mechteld C de Jong
- Division of Endocrine Surgery, National University Health System, 119074, Singapore
| | - Rajeev Parameswaran
- Division of Endocrine Surgery, National University Health System, 119074, Singapore; Yong Loo Lin School of Medicine, 10 Medical Dr, 117597, Singapore.
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10
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Van Raemdonck D, Lambrecht M, Clement P. Should we leave the door closed or open in thymic carcinoma surgery? Eur J Cardiothorac Surg 2022; 62:6563071. [PMID: 35373817 DOI: 10.1093/ejcts/ezac216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/25/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Maarten Lambrecht
- Department of Radiotherapy, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Paul Clement
- Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
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11
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6544688. [DOI: 10.1093/ejcts/ezac159] [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: 09/02/2021] [Revised: 02/11/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
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12
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Shen C, Li J, Li J, Che G. Robot-assisted thoracic surgery versus video-assisted thoracic surgery for treatment of patients with thymoma: A systematic review and meta-analysis. Thorac Cancer 2021; 13:151-161. [PMID: 34806328 PMCID: PMC8758429 DOI: 10.1111/1759-7714.14234] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 02/05/2023] Open
Abstract
Background Surgical resection of the thymus is indicated in the presence of primary thymic diseases such as thymoma. Video‐assisted thoracoscopic surgery (VATS) and robot‐assisted thoracic surgery (RATS) offer a minimally invasive approach to thymectomy. However, there is no clear conclusion whether RATS can achieve an equal or even better surgical effect when compared with VATS in treatment of thymoma. We performed this meta‐analysis to explore and compare the outcomes of RATS versus VATS for thymectomy in patients with thymoma. Methods PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Medline, and Web of Science databases were searched for full‐text literature citations. The quality of the articles was evaluated using the Newcastle–Ottawa Scale and the data analyzed using Review Manager 5.3 software. Fixed or random effect models were applied according to heterogeneity. Subgroup analysis was conducted. Results A total of 11 studies with 1418 patients, of whom 688 patients were in the RATS group and 730 in the VATS group, were involved in the analysis. Compared with VATS, RATS was associated with less blood loss in operation, lower volume of drainage, fewer postoperative pleural drainage days, shorter postoperative hospital stay, and fewer postoperative complications. There was no significant difference in operative time and patients with or without myasthenia gravis between the two groups. Conclusions RATS has more advantages over VATS, indicating that RATS is better than VATS in terms of postoperative recovery. We look forward to more large‐sample, high‐quality randomized controlled studies published in the future.
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Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Jialong Li
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Jue Li
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
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13
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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: 12] [Impact Index Per Article: 4.0] [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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14
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Li H, Ruan Z, Gao F, Zhou H, Guo R, Sun C, Xu Q, Lu Q, Zhou Y, Zhao Z, Yu L, Wu S, Lei T, Gao T, Tang Y, Li C, Huo F, Zhu Y, Sun J, Tang B, Zhang M, Gao Y, Lu X, Li Z, Chang T. Thymectomy and Risk of Generalization in Patients with Ocular Myasthenia Gravis: A Multicenter Retrospective Cohort Study. Neurotherapeutics 2021; 18:2449-2457. [PMID: 34625864 PMCID: PMC8804035 DOI: 10.1007/s13311-021-01129-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 02/05/2023] Open
Abstract
This study aims to investigate the association between thymectomy and the risk of generalization in patients with ocular myasthenia gravis (MG). Data on patients with ocular MG from seven neurological centers in China were retrospectively reviewed. Ocular MG naïve to immunotherapy was categorized according to whether thymectomy was performed (thymectomized group vs. nonsurgical group). Patients in the thymectomized group all underwent surgery within 2 years since ocular symptom onset. The main outcome measure was the generalization. The follow-up period was defined from the date of ocular symptom onset to the date of generalization confirmation, immunotherapy initiation, or last follow-up (defined as 60 months). Of 519 eligible patients (mean [SD] age, 48.7 [15.2] years, 46.6% women), 31 (23.7%) of 131 generalized in the thymectomized group and 122 (31.4%) of 388 did in the nonsurgical group during a median follow-up of 19 months (IQR 8.0-50.0). Thymectomy was independently associated with reduced generalization risk (adjusted HR 0.41, 95% CI 0.25-0.66, P < 0.001). Multivariable stratified analysis also verified this association across the subgroups. Kaplan-Meier curves showed that the 5-year cumulative rate was significantly lower in the thymectomized group than in the nonsurgical group. To conclude, thymectomy may be considered effective in modifying the progression from ocular to generalized MG irrespective of thymoma.
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Affiliation(s)
- Huanhuan Li
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 XinSi Road, Xi'an, 710038, China
| | - Zhe Ruan
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 XinSi Road, Xi'an, 710038, China
| | - Feng Gao
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Rongjing Guo
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 XinSi Road, Xi'an, 710038, China
| | - Chao Sun
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 XinSi Road, Xi'an, 710038, China
| | - Quan Xu
- Department of Thoracic Surgery, Jiangxi Provincial People's Hospital Affiliated To Nanchang University, Nanchang, China
| | - Qiang Lu
- Department of Thoracic Surgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China
| | - Yongan Zhou
- Department of Thoracic Surgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China
| | - Zhengwei Zhao
- Department of Thoracic Surgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China
| | - Liping Yu
- Department of Neurology, Xianyang First People's Hospital, Xianyang, China
| | - Songdi Wu
- Department of Neurology, Xi'an No.1 Hospital, Xi'an, China
| | - Tao Lei
- Department of Neurology, Xi'an Fourth Hospital, Xi'an, China
| | - Ting Gao
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 XinSi Road, Xi'an, 710038, China
| | - Yonglan Tang
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 XinSi Road, Xi'an, 710038, China
| | - Chunhong Li
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 XinSi Road, Xi'an, 710038, China
| | - Feiyan Huo
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 XinSi Road, Xi'an, 710038, China
| | - Ying Zhu
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 XinSi Road, Xi'an, 710038, China
| | - Jie Sun
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 XinSi Road, Xi'an, 710038, China
| | - Baoli Tang
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 XinSi Road, Xi'an, 710038, China
| | - Min Zhang
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 XinSi Road, Xi'an, 710038, China
| | - Yanwu Gao
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 XinSi Road, Xi'an, 710038, China
| | - Xiaodan Lu
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 XinSi Road, Xi'an, 710038, China
| | - Zhuyi Li
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 XinSi Road, Xi'an, 710038, China.
| | - Ting Chang
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 XinSi Road, Xi'an, 710038, China.
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15
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Holleran TJ, Napolitano MA, Crowder HR, Sparks AD, Antevil JL, Trachiotis GD. Clinical Outcomes and Technical Approach of Thymectomy in the Veterans Health Administration. Ann Thorac Surg 2021; 113:1648-1655. [PMID: 34087238 DOI: 10.1016/j.athoracsur.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/08/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Thymectomy is traditionally performed via transsternal incision, but less invasive modalities have emerged, including transcervical, thoracoscopic, and robotic approaches. Despite the advantages of video-assisted thoracoscopic surgery(VATS) over thoracotomy, most thymectomies are performed via sternotomy. This study compared the utilization and 30-day post-operative outcomes of transsternal, transcervical, and VATS thymectomy in the Veterans Health Administration. METHODS This was a retrospective review of veterans that underwent thymectomy via the Veterans Affairs Surgical Quality Improvement Program. 30-day outcomes were compared between techniques, adjusting for confounding covariates. Temporal trends were analyzed using Spearman's rank correlation coefficient, rho(ρ). RESULTS From 2008-2019, 594 thymectomies were performed: 376(63.3%) transsternal, 113(19.0%) VATS(including robotic approaches), and 105(17.7%) transcervical cases. VATS utilization increased from 0% in 2008 to 61% of case volume in 2019. Relative to transsternal technique, VATS thymectomy was associated with decreased odds of pulmonary complications (adjusted odds ratio=0.06;p=0.028) and shorter hospital stay (2.9±0.4 days shorter;p<0.001). No difference in outcomes was detected between VATS and transcervical thymectomy. Post-operative complication rate decreased from 17.7% in 2008 to 5.6% in 2019 (ρ=-0.101;p=0.014). Length of stay decreased from median 4 days in 2008 to 3 days in 2019 (ρ=-0.093;p=0.026). In thymic cancer, VATS 5-year overall survival was non-inferior to transsternal approach(71.3% vs. 74.6%; p=0.54). CONCLUSIONS Transsternal approach comprised most thymectomy cases amongst veterans, while VATS thymectomy utilization increased over time and was associated with favorable outcomes. 30-day outcomes after thymectomy improved over time, which may reflect a trend towards wider utilization of less invasive approaches. Future studies should examine long-term outcomes.
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Affiliation(s)
- Timothy J Holleran
- Division of Cardiothoracic Surgery, Veterans Affairs Medical Center, Washington, DC; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Michael A Napolitano
- Division of Cardiothoracic Surgery, Veterans Affairs Medical Center, Washington, DC; Department of Surgery, George Washington University, Washington, DC
| | - Hannah R Crowder
- Department of Surgery, George Washington University, Washington, DC
| | - Andrew D Sparks
- Department of Surgery, George Washington University, Washington, DC
| | - Jared L Antevil
- Division of Cardiothoracic Surgery, Veterans Affairs Medical Center, Washington, DC
| | - Gregory D Trachiotis
- Division of Cardiothoracic Surgery, Veterans Affairs Medical Center, Washington, DC; Department of Surgery, George Washington University, Washington, DC.
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16
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Introduction of robotic surgery does not negatively affect cardiothoracic surgery resident experience. J Robot Surg 2021; 16:393-400. [PMID: 34024007 DOI: 10.1007/s11701-021-01255-y] [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: 03/11/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
The objective of this study was to evaluate the educational impact following the implementation of a robotic thoracic surgery program on cardiothoracic (CT) surgery trainees. We hypothesized that the introduction of a robotic thoracic surgery program would adversely affect the CT surgery resident experience, decreasing operative involvement and subsequent competency of surgical procedures. CT surgery residents and thoracic surgery attendings from a single academic institution were administered a recurring, electronic survey from September 2019 to September 2020 following each robotic thoracic surgery case. Surveys evaluated resident involvement and operative performance. This study was exempt from review by our Institutional Review Board. Attendings and residents completed surveys for 86 and 75 cases, respectively. Residents performed > 50% of the operation independently at the surgeon console in 66.2 and 73.3% of cases according to attending and resident responses, respectively. The proportion of trainees able to perform > 75% of the operation increased with each increasing year in training (p = 0.002). Based on the Global Evaluative Assessment of Robotic Skills grading tool, third-year residents averaged higher scores compared to first-year residents (22.9 versus 17.4 out of 30 possible points, p < 0.001), indicating that more extensive prior operative experience could shorten the learning curve of robotic thoracic surgery. CT surgery residents remain actively involved in an operative role during the establishment of a robotic thoracic surgery program. The transition to a robotic thoracic surgery platform appears feasible in a large academic setting without jeopardizing the educational experience of resident trainees.
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17
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Abstract
The proportion of robot-assisted thoracic surgery (RATS) is continuously increasing. The main areas of clinical application are anatomical lung resections with lymphadenectomy and resection of mediastinal tumors. Especially in the area of the thymus robot-assisted procedures can now be considered the gold standard. Overall, the limitations of video-assisted thoracoscopic surgery (VATS) can be overcome by the use of robot-assisted surgery and thus a larger proportion of patients can be treated with minimally invasive procedures. The safety of the RATS procedure has been repeatedly demonstrated, although it remains difficult to demonstrate scientifically measurable benefits. With the introduction of new systems on the market further technical evolution and improvement can be expected in the future.
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18
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Trends in Utilization and Perioperative Outcomes in Robotic-assisted Bariatric surgery using the MBSAQIP database: A 4-Year Analysis. Obes Surg 2020; 31:854-861. [PMID: 33165753 DOI: 10.1007/s11695-020-05055-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Robotic-assisted surgery has become increasingly popular across surgical subspecialties. We aimed to analyze trends in the national utilization and outcomes in bariatric surgery. MATERIALS AND METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®) data for 2015-2018 was queried. We included robotic-assisted sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), adjustable gastric band (AGB), biliopancreatic diversion with duodenal switch (BPD-DS), and revisional cases. The Kruskal-Wallis test or Wilcoxon rank-sum were used for comparing continuous variables and Cochran-Armitage trend analysis for categorical variables when comparing years, or with Fisher's Exact Test when directly comparing categories. RESULTS Of 760,076 bariatric cases performed between 2015 and 2018, 7.4% with robotic and 90.4% with laparoscopic approach. SG constituted 61.3% of robotic volume. Utilization of robotic surgery increased 1.96-fold; SG represented the most substantial increase of 2.16-fold, followed by a 1.53-fold in RYGB. The 30-day readmission and re-intervention rates decreased from 5.63% to 4.78% (p<0.01), and 2.31% to 1.46% (p<0.01), respectively. The overall leak rate improved from 0.64% to 0.39% (p=0.01). Mortality and re-operations remained statistically unchanged. When compared to laparoscopic approach, the operative time were significantly longer in the robotic group. Regarding postoperative outcomes, when adjusted for patient characteristics, there were no differences between two approaches except a higher leak rate in robotic group in 2015. CONCLUSION A steady increase in robotic bariatric surgery is apparent. While the operative time remains significantly longer in the robotic group, trends indicate improvement in key quality metrics and patient outcomes as utilization increases.
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Eichhorn M, Haag J, Grünewald C, Reimer P, Winter H. [Robot-assisted Mediastinal Mass Resection]. Zentralbl Chir 2020; 146:111-118. [PMID: 32767302 DOI: 10.1055/a-1192-7205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In recent years, robot-assisted thoracic surgery is gaining more and widespread interest in Europe. Due to the narrow space and the complexity of anatomical structures, conventional minimally invasive mediastinal surgery may be challenging for the thoracic surgeon. Robot-assisted mediastinal surgery opens up new possibilities for minimally invasive surgery, as it permits greater dexterity, a three-dimensional view, and tremor adjustment, which allows the surgeon to perform complex procedures in small thoracic spaces. As robotic platforms continue to evolve, more complex mediastinal thoracic surgical interventions will be facilitated, translating to improved outcomes for patients. This article provides an overview of the current status of robot-assisted mediastinal surgery and summarises general aspects of the indication, set-up and steps of robot-assisted thoracoscopic surgery in mediastinal mass resections.
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Affiliation(s)
- Martin Eichhorn
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Deutschland, Translational Lung Research Center (TLRCH) Heidelberg, Deutsches Zentrum für Lungenforschung (DZL)
| | - Johannes Haag
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Deutschland, Translational Lung Research Center (TLRCH) Heidelberg, Deutsches Zentrum für Lungenforschung (DZL)
| | - Christiane Grünewald
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Deutschland, Translational Lung Research Center (TLRCH) Heidelberg, Deutsches Zentrum für Lungenforschung (DZL)
| | - Peter Reimer
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Deutschland, Translational Lung Research Center (TLRCH) Heidelberg, Deutsches Zentrum für Lungenforschung (DZL)
| | - Hauke Winter
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Deutschland, Translational Lung Research Center (TLRCH) Heidelberg, Deutsches Zentrum für Lungenforschung (DZL)
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