Outcome of Robotic-Assisted Resection of Large Primary Thymic Tumors: A Single High-Volume Institutional Experience

The role of robotic-assisted resection for large primary thymic malignant tumors is uncertain. This study compares outcomes of robotic-assisted resection by tumor size.

Robotic resections for anterior mediastinal masses were identified from an institutionally maintained database and were retrospectively analyzed. Cases were stratified by tumor size. Data points collected included patient demographics, tumor characteristics, and perioperative outcomes.

From 2014 to 2022, 67 robotic-assisted mediastinal resections were performed for primary thymic malignant tumors. The average tumor size was 5.6 cm (range, 0.7-14.0 cm). The median length of stay was 3 days (range, 1-73 days). The median operative time was 186 minutes (range, 69-644 minutes). Tumors ≤4 cm (n = 21; 31%) vs >4 cm (n = 46; 69%), trended toward a shorter median operative time (157 minutes vs 208 minutes; P = .06), length of stay (2 days vs 3.5 days; P = .18), and lower positive margins (21 [100%] R0 resections in the ≤4-cm group vs 40 [87%] R0 resections in the >4-cm group; P = .09). There was no difference in major complications (2 [9.5%] vs 3 [2.5%]; P = 1.0).

Robotic-assisted resection can be safe and effective for primary thymic malignant tumors. Concern regarding increased rates of positive margins vs an open approach for large tumors remain. Although a robotic approach for larger tumors may spare selected patients the morbidity of an open procedure without compromising outcomes, a low threshold should exist for conversion to open surgery.