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Abstract
INTRODUCTION
Increasing evidence supports minimally invasive thymectomy (MIT) for early-stage thymic
malignancies over open median sternotomy thymectomy (MST). However, whether MIT could
be attempted for locally advanced disease remains unclear.
METHODS
The clinical data of consecutive patients with stage T2-3NxM0 (8th edition TNM staging)
thymic malignancies who underwent MIT or MST were identified from a prospectively
maintained database. The co-resected structures were rated with a resection index
(RI) to evaluate surgical difficulty. The impact of surgical approach on treatment
outcomes was investigated through propensity-score matched analysis and multivariable
analysis.
RESULTS
From January 2008 to December 2019, 128 patients were included; MIT was initially
attempted in 58 (45.3%) cases, and 8 (13.8%) were converted to MST during surgery.
The conversion group had similar perioperative outcomes to the MST group, except for
a longer operation time. After propensity-score matching, the RI scores were similar
between the MIT and MST groups (3.5 vs. 3.7, p=0.773). The MIT group had significantly less blood loss (p<0.001), fewer postoperative complications (p=0.048), a shorter duration of chest drainage (p<0.001), and a shorter hospitalization duration (p<0.001) than the MST group. The 5-year freedom from recurrence rate was not different
between the two groups (78.2% vs. 78.5%, p=0.942). In multivariable analysis, surgical approach was not associated with freedom
from recurrence (p=0.727).
CONCLUSIONS
MIT could be safely attempted in carefully selected patients with locally advanced
thymic tumors. Conversion did not compromise surgical outcomes. Patients may benefit
from the less traumatic procedure and thus better recovery, with comparable long-term
oncological outcomes.
Key Words
Abbreviations:
MIT (Minimally invasive thymectomy), MST (Median sternotomy thymectomy), TETs (Thymic epithelial tumors), RI (Resection index), PSM (Propensity-score matched), AJCC (American Joint Committee on Cancer), UICC (Union for International Cancer Control), IASLC (International Association for the Study of Lung Cancer), FFR (Freedom from recurrence), OS (Overall survival), WHO (World Health Organization), VATS (Video-assisted thoracoscopic surgery), ITMIG (International Thymic Malignancy Interest Group), NCCN (National Comprehensive Cancer Network), NCDB (National Cancer Data Base), JART (Japanese Association for Research on the Thymus), ChART (Chinese Alliance for Research in Thymomas), SD (Standard deviation), CI (Confidence interval), IQR (Interquartile range), TC (Thymic carcinoma), NETT (Neuroendocrine thymic tumor)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
December 19,
2022
Received in revised form:
December 7,
2022
Received:
August 17,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
All the authors have completed their ICMJE forms and no conflict of interests.
Funding: The authors report grants from ‘Graded treatment of advanced thymoma under the guidance of multi-dimensional histology’ (YJXT20190104), during the conduct of the study.
CRediT Statement
Zhitao Gu: Conceptualization, Methodology, Validation, Formal analysis, Writing- Original draft preparation
Xiuxiu Hao: Conceptualization, Methodology, Validation, Formal analysis, Writing- Original draft preparation
Yuan Liu: Software, Formal analysis
Ning Xu: Investigation, Data curation
Xuefei Zhang: Investigation, Data curation
Bofei Li: Software, Formal analysis, Visualization
Teng Mao: Resources, Investigation
Wentao Fang: Conceptualization, Methodology, Resources, Supervision, Funding acquisition, Writing-Reviewing and Editing.
Identification
Copyright
© 2023 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.
