Post-Operative Outcomes Associated With Open Versus Robotic Thymectomy: A Propensity Matched Analysis

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Thymectomy is a key procedure for thymic pathologies, including myasthenia gravis and thymic tumors.
• Both open and robotic surgical approaches are utilized, with varying post-operative outcomes.
• Comparative analysis is essential to guide optimal surgical technique selection.

Purpose of the Study:

• To compare post-operative outcomes between open and robotic thymectomy.
• To evaluate the safety and efficacy of robotic thymectomy in a matched cohort.
• To assess the impact of surgical approach on complication rates and hospital stay.

Main Methods:

• Retrospective cohort study of 234 thymectomies (2000-2020) from a single-center registry.
• Propensity-score matching (2:1 open to robotic ratio) created balanced groups (n=114 open, n=59 robotic).
• Surgical time, complication rates (Clavien-Dindo grade ≥2), chest tube duration, and length of stay were primary outcome measures.

Main Results:

• Robotic thymectomy demonstrated significantly shorter surgical time (65 vs 95 min), fewer clinical (6.8% vs 21.1%) and surgical (1.7% vs 11.4%) complications.
• Robotic approach was associated with reduced Clavien-Dindo grade ≥2 complications (15.3% vs 28.1%), shorter chest tube duration (0 vs 3 days), and reduced in-hospital stay (0 vs 5 days).
• Bleeding, ICU stay, reoperation, mortality, and readmission rates were similar between groups; resection rates for tumors were comparable.

Conclusions:

• Robotic thymectomy is associated with significantly improved post-operative outcomes compared to open thymectomy.
• The robotic approach does not compromise oncologic resection goals for thymic epithelial tumors.
• Further long-term follow-up is warranted to definitively establish oncologic equivalence between the two approaches.