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Published on: September 15, 2023
Robotic thymectomy in thymic tumours: a multicentre, nation-wide study
Giovanni Maria Comacchio1, Marco Schiavon1, Carmelina Cristina Zirafa2
1Unit of Thoracic Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
Objectives:
Robotic thymectomy has been suggested and considered technically feasible for thymic tumours. However, because of small-sample series and the lack of data on long-term results, controversies still exist on surgical and oncological results with this approach. We performed a large national multicentre study sought to evaluate the early and long-term outcomes after robot-assisted thoracoscopic thymectomy in thymic epithelial tumours.
Methods:
All patients with thymic epithelial tumours operated through a robotic thoracoscopic approach between 2002 and 2022 from 15 Italian centres were enrolled. Demographic characteristics, clinical, intraoperative, postoperative, pathological and follow-up data were retrospectively collected and reviewed.
Results:
There were 669 patients (307 men and 362 women), 312 (46.6%) of whom had associated myasthenia gravis. Complete thymectomy was performed in 657 (98%) cases and in 57 (8.5%) patients resection of other structures was necessary, with a R0 resection in all but 9 patients (98.6%). Twenty-three patients (3.4%) needed open conversion, but no perioperative mortality occurred. Fifty-one patients (7.7%) had postoperative complications. The median diameter of tumour resected was 4 cm (interquartile range 3-5.5 cm), and Masaoka stage was stage I in 39.8% of patients, stage II in 56.1%, stage III in 3.5% and stage IV in 0.6%. Thymoma was observed in 90.2% of patients while thymic carcinoma occurred in 2.8% of cases. At the end of the follow-up, only 2 patients died for tumour-related causes. Five- and ten-year recurrence rates were 7.4% and 8.3%, respectively.
Conclusions:
Through the largest collection of robotic thymectomy for thymic epithelial tumours we demonstrated that robot-enhanced thoracoscopic thymectomy is a technically sound and safe procedure with a low complication rate and optimal oncological outcomes.
Insights
Robot-assisted thoracoscopic thymectomy is a safe and effective procedure for thymic epithelial tumors, demonstrating excellent oncological outcomes and a low complication rate in a large multicenter study. This robotic approach offers a technically sound option for patients with these rare thoracic neoplasms.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Robotic Surgery
Background:
- Robotic thymectomy is technically feasible for thymic tumors but lacks long-term outcome data.
- Controversies persist regarding the surgical and oncological efficacy of robotic thymectomy.
- A large national multicenter study is needed to evaluate early and long-term outcomes.
Purpose of the Study:
- To evaluate the early and long-term outcomes of robot-assisted thoracoscopic thymectomy for thymic epithelial tumors.
- To assess the safety and efficacy of this minimally invasive approach.
- To address existing controversies regarding robotic thymectomy in thymic malignancies.
Main Methods:
- A retrospective analysis of 669 patients with thymic epithelial tumors undergoing robotic thoracoscopic thymectomy across 15 Italian centers (2002-2022).
- Collection and review of demographic, clinical, intraoperative, postoperative, pathological, and follow-up data.
- Assessment of complete resection, need for conversion to open surgery, perioperative mortality, and postoperative complications.
Main Results:
- 669 patients included, 46.6% with myasthenia gravis; 98% achieved complete thymectomy with R0 resection in 98.6%.
- Low conversion rate (3.4%) and no perioperative mortality; 7.7% postoperative complications.
- 5- and 10-year recurrence rates were 7.4% and 8.3%, respectively, with only 2 tumor-related deaths.
Conclusions:
- Robot-enhanced thoracoscopic thymectomy is a safe and technically sound procedure for thymic epithelial tumors.
- The approach is associated with a low complication rate and optimal oncological outcomes.
- This study provides robust evidence supporting robotic thymectomy in managing thymic malignancies.
