A comparison of three approaches for the treatment of early-stage thymomas: robot-assisted thoracic surgery, video-assisted thoracic surgery, and median sternotomy

Abstract

Background: This aim of this study was to compare three approaches of extended thymectomy for the treatment of early-stage thymomas, which included robot-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS), and median sternotomy (MS) perioperative parameters. Results: A series of intra-and post-operative parameters showed significant differences in intra-operative blood loss volume, mean post-operative pleural drainage duration, pleural drainage volume and mean duration of hospital stay. For these parameters, during further analysis, significant differences were also demonstrated for comparisons between any two groups. RATS reduces the post-operative drainage duration and volume (2.88 vs. 3.77 and 4.41 days, P<0.05; 352.2 vs. 613.9 and 980 mL, P<0.05) and the hospital stay versus the MS and VATS groups (4.3 vs. 5.5 and 6.6 days). Three patients experienced post-operative complications in the MS group, and no post-operative complications occurred in the RATS or VATS group.Conclusions: RATS and VATS both appear feasible and safe for the resection of early-stage thymomas as compared to MS. RATS is less invasive than VATS with a shorter post-operative pleural drainage duration time, a reduced drainage volume, and a shorter hospital stay.

A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy

“…Several of the studies had a high risk of selection bias due to historical controls (24,32,34,36,37), differences in criteria for patient selection (22,33), or patient characteristic differences between groups (23). Studies that performed propensity score matching for outcomes of interest were considered at low risk for selection bias (25,(27)(28)(29)(30)35), as were the papers by Qian et al (31) and Ye et al (39), due to contemporary controls, the same selection criteria, and no differences in patient characteristics. Most of the studies were rated as unknown or high risk for performance bias due to a lack of information provided on surgical techniques and care pathways.…”

“…The paper by Weksler et al (36) was assessed as having a high risk of detection bias because the authors specifically mentioned not being able to obtain accurate operative times for the transsternal group and did not report all of the same outcomes for each group. All of the other studies were rated as unclear risk due to a lack of information (22,24,26,28,35,39), or as low risk of detection bias due to prospectively collected data (27,33,34,37), data entry into a registry (23), precise definitions of outcomes provided (25,29,30,38), or because any missing definitions were unlikely to affect outcomes (31,32). The study by Weksler et al (36) was also assessed as high risk for attrition bias because of incomplete data that was likely due to intervention type.…”

“…Of those, 12 reported data in sufficient detail for metaanalysis (22,24,25,(27)(28)(29)(30)(31)(32)35,37,38), which showed equivalent operative time for robotic thymectomy vs. open surgery (WMD: 6.73; 95% CI: −21.20, 34.66, P=0.64) with significant heterogeneity (P<0.00001, I 2 =97%), perhaps due to differences in definitions of operative time between studies. Eight studies reported on intraoperative blood loss (EBL) (27)(28)(29)31,32,36,37,39), of these, seven reported EBL in enough detail for pooled analysis ( Figure 3B) (27)(28)(29)31,36,37,39), which showed significantly lower blood loss in the robotic group (WMD: −173.03; 95% CI: −305.90, −40.17, P=0.01), but with significant heterogeneity (P<0.00001, I 2 =99%) due to large variance in the magnitude of the robotic benefit; all seven papers reported significantly lower EBL for the robotic group. Only one study reported on blood transfusions (R 0% vs. O 0%, ns) (38).…”

“…Only one study reported on blood transfusions (R 0% vs. O 0%, ns) (38). Length of hospital stay (LOS) was reported in 13 publications (22,24,25,(27)(28)(29)(30)(31)(32)(35)(36)(37)(38). Pooled analysis showed a significantly shorter hospital stay ( Figure 3C) in the robotic group (WMD: −2.78; 95% CI: −3.22, −2.33, P<0.00001), with significant heterogeneity (P=0.0002, I 2 =67%), which appears to be due to variability in the degrees of benefit in the robotic group as all studies reported a shorter LOS in the robotic group.…”

Outcomes of Extended Thymectomy in Myasthenic and Non-Myasthenic Thymus Tumors

“…Timusun ve anterior mediastinal yağ dokusunun en blok rezeksiyonu olarak tarif edilen bir prosedür olan genişletilmiş timektomi, timomaların standart cerrahi tedavisi olarak kabul görmektedir 3,4 . Timektomi medyan sternotomi, video yardımlı torasik cerrahi (VATS) veya robotik cerrahi ile yapılabilir 3,4,5 .…”