Objective: This study aimed to evaluate the therapeutic efficacy of thymectomy through a subxiphoid video ethoracoscopic approach with double elevation of the sternum compared with traditional intercostal uniportal video-assisted thoracic surgery for stage IeII thymic epithelial tumors (using the Masaoka-Koga staging system). Method: Patients with thymic tumors underwent resection through intercostal video-assisted thoracic surgery or subxiphoid videoethoracoscopic approach. Only those with pathologically confirmed thymic epithelial tumors were enrolled. Perioperative short-term/long-term outcomes were compared between 2 groups after propensity-score matching. Results: A total of 141 patients diagnosed with thymic epithelial tumors and scheduled for minimally invasive surgery were included. In the intercostal video-assisted thoracic surgery group, the prevalence for conversion to open surgery was higher than in the subxiphoid videoethoracoscopic approach group for stage III thymic tumors (P ¼ .019). After propensity-score matching for 122 patients undergoing video-assisted thoracic surgery, significantly larger resected specimens were found in the subxiphoid videoethoracoscopic approach group compared to the intercostal video-assisted thoracic surgery group (11.7 ± 3.8 vs 7.1 ± 2.7 cm, P < .001). The pain score on the first postoperative day (1.6 ± 0.6 vs 2.0 ± 0.7, P ¼.011) and the day of hospital discharge (1.2 ± 0.7 vs 1.6 ± 0.6, P ¼ .017) in the subxiphoid videoethoracoscopic approach group were significantly lower. The operation time (168.4±59.3 vs 92.5±46.0min,P<.001), chest tube drainage time (3.6±1.2 vs 2.9± 0.9 days, P ¼.001), and hospital stay (3.7 ± 1.3 vs 2.9 ± 0.9 days, P ¼.004) were longer in the subxiphoid video ethoracoscopic approach group,with higherintraoperative bloodloss (69.3±61.0 vs 45.6±42.5mL, P¼.045). No significant differences were found in the hospitalization cost, incidence of complications, or 3 year disease-free survival (96% vs 92%, P ¼ .473) between the 2 groups. Four patients with stage III disease in the subxiphoid videoethoracoscopic approach group reached a 3-year disease-free survival of 75%. Conclusion: The subxiphoid videoethoracoscopic approach with double elevation of the sternum shows the potential for more extensive clearance of thymic tissue for thymic epithelial tumors compared to intercostal video-assisted thoracic surgery. Its inferior operation time and blood loss could be a trade-off for improved pain control and equivalent hospitalization cost, complications, and 3-year disease-free survival. The subxiphoid videoethoracoscopic approach may offer an advantage treatment for early-stage thymic epithelial tumors and may also be suitable for unexpected advanced thymic tumors identified intraoperatively.

Double sternal elevation subxiphoid versus uniportal thoracoscopic thymectomy associated with superior clearance for stage I–II thymic epithelial tumors: Subxiphoid thymectomy compared with VATS / Nan Song, Qiuyuan Li, Beatrice Aramini, Xinnan Xu, Yuming Zhu, Gening Jiang, Xing Wang, Jiang Fan.. - In: SURGERY. - ISSN 0039-6060. - ELETTRONICO. - 172:1(2022), pp. 371-378. [10.1016/j.surg.2021.12.034]

Double sternal elevation subxiphoid versus uniportal thoracoscopic thymectomy associated with superior clearance for stage I–II thymic epithelial tumors: Subxiphoid thymectomy compared with VATS.

Beatrice Aramini
Writing – Review & Editing
;
2022

Abstract

Objective: This study aimed to evaluate the therapeutic efficacy of thymectomy through a subxiphoid video ethoracoscopic approach with double elevation of the sternum compared with traditional intercostal uniportal video-assisted thoracic surgery for stage IeII thymic epithelial tumors (using the Masaoka-Koga staging system). Method: Patients with thymic tumors underwent resection through intercostal video-assisted thoracic surgery or subxiphoid videoethoracoscopic approach. Only those with pathologically confirmed thymic epithelial tumors were enrolled. Perioperative short-term/long-term outcomes were compared between 2 groups after propensity-score matching. Results: A total of 141 patients diagnosed with thymic epithelial tumors and scheduled for minimally invasive surgery were included. In the intercostal video-assisted thoracic surgery group, the prevalence for conversion to open surgery was higher than in the subxiphoid videoethoracoscopic approach group for stage III thymic tumors (P ¼ .019). After propensity-score matching for 122 patients undergoing video-assisted thoracic surgery, significantly larger resected specimens were found in the subxiphoid videoethoracoscopic approach group compared to the intercostal video-assisted thoracic surgery group (11.7 ± 3.8 vs 7.1 ± 2.7 cm, P < .001). The pain score on the first postoperative day (1.6 ± 0.6 vs 2.0 ± 0.7, P ¼.011) and the day of hospital discharge (1.2 ± 0.7 vs 1.6 ± 0.6, P ¼ .017) in the subxiphoid videoethoracoscopic approach group were significantly lower. The operation time (168.4±59.3 vs 92.5±46.0min,P<.001), chest tube drainage time (3.6±1.2 vs 2.9± 0.9 days, P ¼.001), and hospital stay (3.7 ± 1.3 vs 2.9 ± 0.9 days, P ¼.004) were longer in the subxiphoid video ethoracoscopic approach group,with higherintraoperative bloodloss (69.3±61.0 vs 45.6±42.5mL, P¼.045). No significant differences were found in the hospitalization cost, incidence of complications, or 3 year disease-free survival (96% vs 92%, P ¼ .473) between the 2 groups. Four patients with stage III disease in the subxiphoid videoethoracoscopic approach group reached a 3-year disease-free survival of 75%. Conclusion: The subxiphoid videoethoracoscopic approach with double elevation of the sternum shows the potential for more extensive clearance of thymic tissue for thymic epithelial tumors compared to intercostal video-assisted thoracic surgery. Its inferior operation time and blood loss could be a trade-off for improved pain control and equivalent hospitalization cost, complications, and 3-year disease-free survival. The subxiphoid videoethoracoscopic approach may offer an advantage treatment for early-stage thymic epithelial tumors and may also be suitable for unexpected advanced thymic tumors identified intraoperatively.
2022
Double sternal elevation subxiphoid versus uniportal thoracoscopic thymectomy associated with superior clearance for stage I–II thymic epithelial tumors: Subxiphoid thymectomy compared with VATS / Nan Song, Qiuyuan Li, Beatrice Aramini, Xinnan Xu, Yuming Zhu, Gening Jiang, Xing Wang, Jiang Fan.. - In: SURGERY. - ISSN 0039-6060. - ELETTRONICO. - 172:1(2022), pp. 371-378. [10.1016/j.surg.2021.12.034]
Nan Song, Qiuyuan Li, Beatrice Aramini, Xinnan Xu, Yuming Zhu, Gening Jiang, Xing Wang, Jiang Fan.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/881589
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