Robotic Thymectomy for Thymomas: A Retrospective Follow-up Study in the Netherlands

Abstract

BACKGROUND The Maastricht University Medical CenterD is a Dutch center of expertise appointed by the Netherlands Federation of University Medical Centers for the treatment of thymomas. The aim of this study was to investigate the long-term oncologic, surgical, and neurologic outcomes of all patients who underwent a robotic thymectomy for a thymoma at Maastricht University Medical CenterD.METHODS We retrospectively analyzed the clinical-pathologic data of all consecutive patients with a thymoma who underwent robotic thymectomy using the DaVinci robotic system at Maastricht University Medical CenterD between April 2004 and December 2018. Follow-up data were collected from 60 referring Dutch hospitals. RESULTSIn total, 398 robotic thymectomies were performed, and 130 thymomas (32.7%) were found. Median followup time was 46 months; median procedure time, 116 minutes; and median hospitalization time, 3 days. In 8.4% of patients, a conversion was performed, and in 20.8%, a complication was registered. The majority of myasthenic patients with a thymoma went into remission, mostly within 12 to 24 months after thymectomy (81%). No statistical difference was found in the number of complications, conversions, incomplete resections, or deaths between patients with myasthenia gravis and nonmyasthenic patients. Thirty-six patients (27.7%) underwent postoperative radiotherapy. The recurrence rate was 9.1%, and the 5-year thymoma-related survival rate was 96.6%.CONCLUSIONS Robotic thymectomy was found to be safe and feasible for early stage thymomas, most advancedstage thymomas, and thymomatous myasthenia gravis. A national guideline could contribute to the improvement of the oncologic follow-up of thymic epithelial tumors in the Netherlands.

Long‐term outcomes of robot‐assisted radical thymectomy for large thymomas: A propensity matched analysis

“…6,7 On the other hand, other authors 8,9,13 did not consider any threshold diameter of minimally-invasive thymectomy and they consider every patients suitable for minimally-invasive thymectomy, excluding those with vascular invasion on the superior vena cava, brachiocephalic vein and aorta. Data regarding RATSthymectomy are weak on this argument, but previous published paper 10,[21][22][23] reported the safety and effectiveness of RATSthymectomy also for large lesions. In our practice, we select…”

“…On the other hand, other authors 8,9,13 did not consider any threshold diameter of minimally‐invasive thymectomy and they consider every patients suitable for minimally‐invasive thymectomy, excluding those with vascular invasion on the superior vena cava, brachiocephalic vein and aorta. Data regarding RATS‐thymectomy are weak on this argument, but previous published paper 10,21–23 reported the safety and effectiveness of RATS‐thymectomy also for large lesions. In our practice, we select patients for RATS‐thymectomy independently to the diameter at the preoperative CT‐scan, but we based our choice on the location of the thymoma and on the absence of an invasive behaviour on the vascular structure of the mediastinum.…”

Robotic Mediastinal Tumor Resections: Position and Port Placement

“…An assistant suction device can be used between the camera port and left arm port if necessary. A right-side approach has a wider field of view and larger working space [ 14 , 15 , 16 , 17 , 18 , 19 ], whereas a left-side approach potentially accesses more thymic tissue and allows easier visualization of the contralateral phrenic nerve [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Although it is controversial whether a left-side or right-side approach is better, several recent studies have reported using the left-side approach for extended thymectomy in patients with MG because it provides enhanced visualization and reduces the probability of phrenic nerve injury [ 21 , 25 , 27 , 28 ].…”

Thoracic surgery in the Netherlands

“…Historically, the anterior mediastinum was approached through sternotomy, and therefore performed in many (cardio)thoracic surgery centers in the Netherlands. However, due to the relatively low incidence of anterior mediastinal masses and the advent of subspecialized minimally invasive and robotic surgery, thymic and mediastinal surgery can now be considered complex care and is only performed in selected centers; tertiary centers perform surgery of advanced thymoma (Masaoka stages > III) and mediastinal tumors ( 45 ), whereas high-volume secondary centers conduct resections of low-grade thymoma (Masaoka stages I–III) and mediastinal tumors. In these medical centers, a minimally invasive approach, either thoracoscopically or robotically, is now standard of care.…”