Endoscopic lymph node dissection for thymic malignancies: lateral thoracic intercostal and subxiphoid approaches

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• The role of lymph node dissection in thymic malignancies is not well-defined.
• Endoscopic surgical techniques are increasingly used for thymic malignancies.

Purpose of the Study:

• To compare lymph node dissection capabilities of lateral thoracic intercostal and subxiphoid approaches for thymic malignancies.
• To analyze patterns of lymph node metastasis based on surgical approach.

Main Methods:

• Comparative analysis of lymph node dissection extent based on VATS lateral thoracic and subxiphoid approaches.
• Discussion of surgical strategy considering patient positioning and anatomical landmarks.

Main Results:

• The VATS lateral approach has limitations for contralateral anterior lymph nodes but is suitable for deep-region nodes.
• The subxiphoid approach provides excellent visualization of the anterior region and phrenic nerves, similar to median sternotomy.
• Deep-region lymph node dissection is more challenging with the subxiphoid approach compared to the lateral thoracic approach.

Conclusions:

• Thorough anterior lymph node dissection for thymic malignancies can be achieved with either the subxiphoid or bilateral lateral thoracic approach.
• The subxiphoid approach is potentially superior to the VATS lateral approach for anterior lymph node dissection due to its midline visualization.