A robotic-assisted thymectomy is equivalent to a transsternal resection in large thymomas

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Robotic-assisted thoracoscopic surgery (RATS) is established for small thymomas.
• Data comparing RATS to open thymectomy (OT) for large thymomas (≥5 cm) is limited.
• This study evaluates RATS vs. OT for large thymomas.

Purpose of the Study:

• To compare oncological and perioperative outcomes of RATS and OT for thymomas ≥5 cm.
• To assess overall survival (OS), length of stay (LOS), and mortality rates.
• To determine the feasibility of RATS for larger thymic tumors.

Main Methods:

• Retrospective analysis of the National Cancer Database (2010-2020).
• Inclusion of patients with thymomas ≥5 cm, excluding thymic carcinoma and neoadjuvant therapy.
• Propensity score-matched analysis (1:1) comparing RATS and OT outcomes.

Main Results:

• 1,178 patients (163 RATS, 1,015 OT) were analyzed; RATS cases were more frequent in academic centers.
• Matched cohort showed no significant difference in 30-day readmission or mortality rates between RATS and OT.
• RATS was associated with a shorter median length of stay (LOS).
• 5-year OS was 88% for OT and 90% for RATS (P=0.23); surgical approach did not predict survival.

Conclusions:

• RATS is a viable option for thymomas ≥5 cm.
• RATS offers comparable oncological and perioperative results to OT for large thymomas.
• RATS demonstrates a shorter LOS compared to OT in this patient group.