Robot-aided thoracoscopic thymectomy for early-stage thymoma: a multicenter European study

J Thorac Cardiovasc Surg. 2012 Nov;144(5):1125-30. doi: 10.1016/j.jtcvs.2012.07.082. Epub 2012 Aug 31.

Abstract

Objective: Minimally invasive thymectomy for stage I to stage II thymoma has been suggested in recent years and considered technically feasible. However, because of the lack of data on long-term results, controversies still exist on surgical access indication. We sought to evaluate the results after robot-assisted thoracoscopic thymectomy in early-stage thymoma.

Methods: Data were collected from 4 European centers. Between 2002 and 2011, 79 patients (38 men and 41 women; median age, 57 years) with early-stage thymoma were operated by left-sided (82.4%), right-sided (12.6%), or bilateral (5%) robotic thoracoscopic approach. Forty-five patients (57%) had associated myasthenia gravis.

Results: Average operative time was 155 minutes (range, 70-320 minutes). One patient needed open conversion, in 1 patient a standard thoracoscopy was performed after robotic system breakdown, and in 5 patients an additional access was required. No vascular and nervous injuries were recorded, and no perioperative mortality occurred. Ten patients (12.7%) had postoperative complications. Median hospital stay was 3 days (range, 2-15 days). Median diameter of tumor resected was 3 cm (range, 1-12 cm), and Masaoka stage was stage I in 30 patients (38%) and stage II in 49 patients (62%). At a median follow-up of 40 months, 74 patients were alive and 5 had died (4 patients from nonthymoma-related causes and 1 from a diffuse intrathoracic recurrence), with a 5-year survival rate of 90%.

Conclusions: Our data indicate that robot-enhanced thoracoscopic thymectomy for early-stage thymoma is a technically sound and safe procedure with a low complication rate and a short hospital stay. Oncologic outcome seems good, but a longer follow-up is needed to consider this as a standard approach definitively.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Europe
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Length of Stay
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Neoplasms, Glandular and Epithelial / diagnostic imaging
  • Neoplasms, Glandular and Epithelial / mortality
  • Neoplasms, Glandular and Epithelial / pathology
  • Neoplasms, Glandular and Epithelial / surgery*
  • Postoperative Complications / etiology
  • Postoperative Complications / therapy
  • Retrospective Studies
  • Robotics*
  • Surgery, Computer-Assisted* / adverse effects
  • Surgery, Computer-Assisted* / mortality
  • Thoracic Surgery, Video-Assisted* / adverse effects
  • Thoracic Surgery, Video-Assisted* / mortality
  • Thymectomy / adverse effects
  • Thymectomy / methods*
  • Thymectomy / mortality
  • Thymus Neoplasms / diagnostic imaging
  • Thymus Neoplasms / mortality
  • Thymus Neoplasms / pathology
  • Thymus Neoplasms / surgery*
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Young Adult

Supplementary concepts

  • Thymic epithelial tumor