Xinyu Yang1, Shuai Wang1, Jiahao Jiang1, Miao Lin1, Jian Gao1, Hao Wang2, Lijie Tan3, Jianyong Ding4. 1. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. 2. Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China. 3. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. tan.lijie@zs-hospital.sh.cn. 4. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. ding.jianyong@zs-hospital.sh.cn.
Abstract
BACKGROUND: The appropriate approach for video-assisted thoracic surgery for early-stage thymoma remains debatable. The current study compared the safety and feasibility between subxiphoid-approach thoracoscopic thymectomy (SATT) and lateral intercostal-approach thoracoscopic thymectomy (LATT) for Masaoka-Koga stages 1 and 2 thymoma. METHODS: The study retrospectively enrolled 461 patients without myasthenia gravis who underwent SATT or LATT at the Zhongshan Hospital of Fudan University between 2016 and 2020. A 1:1 propensity score-matching (PSM) analysis was performed to control for selection bias. A series of perioperative outcomes, including surgical outcomes, inflammatory factors, morbidity and mortality, pain assessment, and quality of life, were compared. RESULTS: Each group consisted of 144 patients after PSM. The results showed that the SATT group had a significantly higher rate of exposure to the bilateral phrenic nerves (SATT [98.6 %] vs. LATT [77.1 %]; p < 0.001) as well as a larger maximum length (9.20 ± 3.08 vs. 7.52 ± 3.44 cm; p < 0.001) and width (6.13 ± 1.81 vs. 5.04 ± 1.77 cm; p < 0.001) of resected tissue than the LATT group. In addition, the SATT group had lower postoperative high-sensitivity C-reactive protein (hs-CRP) levels (9.37 ± 2.17 vs. 12.69 ± 2.13 mg/L; p < 0.001), better postoperative days 1, 3, and 7 visual analog pain scale (VAS) scores (p < 0.001), and better postoperative days 30 and 90 quality of life (p < 0.05). However, the two groups showed no significant increase in surgical time, estimated blood loss, total drainage time, postoperative total drainage volume, complications, or postoperative hospital stays. CONCLUSIONS: The study results suggest that the SATT is feasible and safe for Masaoka-Koga stages 1 and 2 thymoma.
BACKGROUND: The appropriate approach for video-assisted thoracic surgery for early-stage thymoma remains debatable. The current study compared the safety and feasibility between subxiphoid-approach thoracoscopic thymectomy (SATT) and lateral intercostal-approach thoracoscopic thymectomy (LATT) for Masaoka-Koga stages 1 and 2 thymoma. METHODS: The study retrospectively enrolled 461 patients without myasthenia gravis who underwent SATT or LATT at the Zhongshan Hospital of Fudan University between 2016 and 2020. A 1:1 propensity score-matching (PSM) analysis was performed to control for selection bias. A series of perioperative outcomes, including surgical outcomes, inflammatory factors, morbidity and mortality, pain assessment, and quality of life, were compared. RESULTS: Each group consisted of 144 patients after PSM. The results showed that the SATT group had a significantly higher rate of exposure to the bilateral phrenic nerves (SATT [98.6 %] vs. LATT [77.1 %]; p < 0.001) as well as a larger maximum length (9.20 ± 3.08 vs. 7.52 ± 3.44 cm; p < 0.001) and width (6.13 ± 1.81 vs. 5.04 ± 1.77 cm; p < 0.001) of resected tissue than the LATT group. In addition, the SATT group had lower postoperative high-sensitivity C-reactive protein (hs-CRP) levels (9.37 ± 2.17 vs. 12.69 ± 2.13 mg/L; p < 0.001), better postoperative days 1, 3, and 7 visual analog pain scale (VAS) scores (p < 0.001), and better postoperative days 30 and 90 quality of life (p < 0.05). However, the two groups showed no significant increase in surgical time, estimated blood loss, total drainage time, postoperative total drainage volume, complications, or postoperative hospital stays. CONCLUSIONS: The study results suggest that the SATT is feasible and safe for Masaoka-Koga stages 1 and 2 thymoma.