Robot versus video-assisted thymectomy for large thymomas: A propensity- matched analysis

Abstract

Abstract Background Both video-assisted thymectomy (VAT) and robot-assisted thymectomy (RAT) have been suggested as technically sound approaches for early-stage thymomas. However, the choice of VAT or RAT for large and advanced thymomas remains controversial. In this study, the perioperative outcomes of VAT and RAT were compared in patients with large thymomas (size ≥5.0 cm). Methods A total of 113 patients with large thymomas who underwent minimally invasive surgery were included. Sixty-three patients underwent RAT, and 50 patients underwent VAT. Patient characteristics and perioperative variables were compared. Results Compared with the VAT group, the RAT group experienced a shorter operation time (median: 110 min vs.130 min; P < 0.001) and less blood loss (30.00 ml vs. 100.00 ml, P < 0.001). No patients in the RAT group needed conversion to open surgery, but in the VAT series, five patients required conversion to open procedures (0% vs. 14.29%, P = 0.054). The rate of concomitant resection in the RAT group was similar to that in the VAT group (11.43% vs. 5.71%; P = 0.673). There was no significant difference between the two groups in the duration of chest tube (P = 0.587), postoperative complications (P = 1.000), and the duration of postoperative hospital stay (P = 0.141). Conclusion For large thymomas, RAT can be performed safely and effectively in a radical fashion. Due to the advanced optics and precise instrument control, concomitant resections can be easily achieved in larger thymomas using the robotic approach.