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Minimally Invasive Thymectomy Could Be Attempted for Locally Advanced Thymic Malignancies: A Real-World Study with Propensity-score Matched Analysis

  • Author Footnotes
    ∗ Zhitao Gu and Xiuxiu Hao contributed equally to this study.
    Zhitao Gu
    Footnotes
    ∗ Zhitao Gu and Xiuxiu Hao contributed equally to this study.
    Affiliations
    Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Author Footnotes
    ∗ Zhitao Gu and Xiuxiu Hao contributed equally to this study.
    Xiuxiu Hao
    Footnotes
    ∗ Zhitao Gu and Xiuxiu Hao contributed equally to this study.
    Affiliations
    Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Yuan Liu
    Affiliations
    Statistics Center, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Ning Xu
    Affiliations
    Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Xuefei Zhang
    Affiliations
    Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Bofei Li
    Affiliations
    Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Teng Mao
    Affiliations
    Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Wentao Fang
    Correspondence
    Corresponding author: Professor Wentao Fang, Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, 241 Huaihai Road West, Shanghai 200030, China.
    Affiliations
    Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Author Footnotes
    ∗ Zhitao Gu and Xiuxiu Hao contributed equally to this study.
Published:January 12, 2023DOI:https://doi.org/10.1016/j.jtho.2022.12.013
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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)
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