Effect Evaluation of Subxiphoid and Intercostal Thymectomy: A Meta-Analysis and Systematic Review

Abstract

BackgroundIt still remains unclear whether subxiphoid video-assisted thoracoscopic surgery (SVATS) thymectomy is safe and reasonable. This meta-analysis aims at assessing the effectiveness and safety of SVATS for thymoma in comparison with that of intercostal video-assisted thoracoscopic surgery (IVATS) thymectomy.MethodsAll the relevant data systematically analyzed in this thesis were retrieved from PubMed, the Cochrane Library, web of science, EMBASE, and ClinicalTrials.gov. The time span for data retrieval was from the date of database establishment to March 2022. The outcome indicators include operation time, intraoperative blood loss, duration of postoperative drainage, postoperative hospital days, visual analogue scale (VAS) score on the day of operation, VAS score on postoperative day 3, and VAS score on postoperative day 7; postoperative complications were analyzed in our meta-analysis.ResultsIn 13 studies of this paper, there were 1,198 cases included. Among them, 563 cases were treated by SVATS thymectomy and 635 cases by IVATS thymectomy. There was no significant difference in the operation time [113.38 vs. 119.91 min, 95% confidence interval (CI): −0.70–0.15, p = 0.20) and the incidence of intraoperative and postoperative complications (RR = 0.82, 95% CI: 0.58–1.15, p = 0.25) between SVATS thymectomy and IVATS thymectomy. However, SVATS thymectomy significantly reduced the amount of intraoperative blood loss (47.68 vs. 66.69 mL, SMD = −0.57, 95% CI: −0.95 to −0.18, p = 0.004), postoperative drainage days (2.12 vs. 2.72 days, SMD = −0.46, 95% CI: −0.74 to −0.18, p = 0.001), postoperative hospital stays (4.53 vs. 5.91 days, SMD = −0.64, 95% CI: −0.96 to −0.31, p = 0.0001), and VAS scores after the operation.DiscussionSVATS thymectomy is safe and feasible, and the perioperative effect is better than IVATS thymectomy to a certain extent, which is worthy of popularization and further research.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/

Thymus Surgery Prospectives and Perspectives in Myasthenia Gravis

“…Complications related to thymotomy may occur due to the following conditions: acute myasthenic crisis, nosocomial infections, lesions of the recurrent laryngeal nerves, or phrenic nerves [ 40 ].…”

Thymectomy in Children

“…Besides the commonly used techniques of thymectomy, some rare surgical procedures have also been reported to treat thymic diseases. Pure mediastinoscopic thymectomy, subxiphoid thymectomy, and partial thymectomy can be mentioned among these ones, but will not be discussed here [37].…”

“…As an alternative to conventional left-sided thoracoscopic approach, thymectomy with subxiphoid access, whether single port or not, or a right-sided approach in cases where the thymic lesion was almost totally located on the right side has been reported [37].…”

Surgical Treatment of Stage I and II Thymus Epithelial Tumors

“…Так, в метаанализ Н. Wang и соавт. [53] С момента создания современной TNM-классификации для ЭОТ и разграничения N-статуса при стадировании опухолевого процесса возник вопрос о выделении путей лимфогенного метастазирования. В целях унификации лимфодиссекции с подачи ITMIG создана карта регионарного метастазирования при ЭОТ.…”