Minimally invasive surgery in the management of resectable thymoma: a retrospective analysis from the National Cancer Database

Salfity, Hai; Timsina, Lava; Ceppa, DuyKhanh P.; Birdas, Thomas J.

doi:10.21037/jtd-20-2660

Cited by 8 publications

(5 citation statements)

References 31 publications

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“…In addition, a large cohort study based on the national cancer database conducted by Salfity et al, comparing VATS (305 cases), robotic (342 cases) and open (1665 cases) thymectomy, showed encouraging oncological outcomes associated with MIS procedures. The authors indeed noticed a higher radical resection rate and better survival in the robotic group [31].…”

Section: Discussionmentioning

confidence: 82%

National Multicenter Study on the Comparison of Robotic and Open Thymectomy for Thymic Neoplasms in Myasthenic Patients: Surgical, Neurological and Oncological Outcomes

Sicolo,

Zirafa,

Romano

et al. 2024

Cancers

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Thymectomy is the gold standard in the treatment of thymic neoplasm and plays a key role in the therapeutic path of myasthenia gravis. For years, sternotomy has been the traditional approach for removing anterior mediastinal lesions, although the robotic thymectomy is now widely performed. The literature is still lacking in papers comparing the two approaches and evaluating long-term oncological and neurological outcomes. This study aims to analyze the postoperative results of open and robotic thymectomy for thymic neoplasms in myasthenic patients. Surgical, oncological and neurological data of myasthenic patients affected by thymic neoplasms and surgically treated with extended thymectomy, both with the open and the robotic approach, in six Italian Thoracic Centers between 2011 and 2021 were evaluated. A total of 213 patients were enrolled in the study: 110 (51.6%) were treated with the open approach, and 103 (48.4%) were treated with robotic surgery. The open surgery, compared with the robotic, presented a shorter operating time (p < 0.001), a higher number of postoperative complications (p = 0.038) and longer postoperative hospitalization (p = 0.006). No other differences were observed in terms of surgical, oncological or neurological outcomes. The robotic approach can be considered safe and feasible, comparable to the open technique, in terms of surgical, oncological and neurological outcomes.

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Section: Discussionmentioning

confidence: 82%

National Multicenter Study on the Comparison of Robotic and Open Thymectomy for Thymic Neoplasms in Myasthenic Patients: Surgical, Neurological and Oncological Outcomes

Sicolo,

Zirafa,

Romano

et al. 2024

Cancers

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“…A total of 10 articles [ 10 , 13 , 14 , 16 , 18 , 22 – 26 ] reported the tumor size of the two groups of patients, involving a total of 1346 patients. There was statistical heterogeneity between the studies ( P < 0.00001, I 2 = 83%, so a random-effects model was used for data analysis.…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of clinical efficacy of thoracoscopy and robotic surgery in the treatment of mediastinal tumors

Dang,

Sun,

et al. 2024

World J Surg Onc

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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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“…However, additional considerations may include inability to access experienced thoracic surgeons, concerns regarding surgical morbidity, and lack of awareness of the disease-specific benefits associated with resection from both a provider and payer perspective. The increased adoption of minimally-invasive surgical techniques for thymic disease ( 16 ), and the associated reduction in pain and morbidity with these approaches ( 17 ), may mitigate previous concerns regarding the use of surgery for disease control in NTMG. Finally, as many studies within medicine have noted, randomized trial and guideline-based evidence often takes several years to affect “real world” clinical practice ( 18 , 19 ).…”

Section: Discussionmentioning

confidence: 99%

Outcomes after thymectomy in non-thymomatous myasthenia gravis

Deboever¹,

Ying²,

Feldman³

et al. 2023

J Thorac Dis

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Background Guidelines by the myasthenia gravis (MG) Foundation of America suggest patients aged 18 to 50 years with non-thymomatous myasthenia gravis (NTMG) benefit from thymectomy. Our objective was to investigate utilization of thymectomy in NTMG patients outside the confines of a clinical trial. Methods From the Optum de-identified Clinformatics Data Mart Claims Database (2007 to 2021), we identified patients diagnosed with MG between 18–50 years old. We then selected patients who received a thymectomy within 12 months of MG diagnosis. Outcomes included use of steroids, non-steroidal immunosuppressive agents (NSIS), and rescue therapy (plasmapheresis or intravenous immunoglobulin), as well as NTMG-related emergency department (ED) visits and hospital admissions. These outcomes were compared in the 6-months before and after thymectomy. Results A total of 1,298 patients met our inclusion criteria, of whom 45 (3.47%) received a thymectomy, performed via minimally invasive surgery in 53.3% of cases (n=24). In comparing the pre- to post-operative period, we noted that steroid use increased (53.33% to 66.67%, P=0.034), NSIS use remained stable, and use of rescue therapy decreased (44.44% to 24.44%, P=0.007). Costs associated with steroid and NSIS use remained stable. However, the mean costs of rescue therapy decreased (from $13,243.98 to $8,486.26, P=0.035). Hospital admissions and ED visits related to NTMG remained stable. There were 2 readmissions within 90 days (4.44%) associated with thymectomy. Conclusions Patients with NTMG undergoing thymectomy experienced less need for rescue therapy following resection, albeit with increased rates of steroid prescriptions. Thymectomy is infrequently performed in this patient population despite acceptable postsurgical outcomes.

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Minimally invasive surgery in the management of resectable thymoma: a retrospective analysis from the National Cancer Database

Cited by 8 publications

References 31 publications

National Multicenter Study on the Comparison of Robotic and Open Thymectomy for Thymic Neoplasms in Myasthenic Patients: Surgical, Neurological and Oncological Outcomes

National Multicenter Study on the Comparison of Robotic and Open Thymectomy for Thymic Neoplasms in Myasthenic Patients: Surgical, Neurological and Oncological Outcomes

Meta-analysis of clinical efficacy of thoracoscopy and robotic surgery in the treatment of mediastinal tumors

Outcomes after thymectomy in non-thymomatous myasthenia gravis

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