Robot-assisted versus open thymectomy a systematic review and meta-analysis of propensity score matched studies

Thymectomy can be achieved through open surgery or minimally invasive approaches including video-assisted and robot-assisted thoracoscopic surgery. The present review aimed to compare the operative and postoperative outcomes of open and robot-assisted thymectomy (RAT) by analysis of published propensity score matched studies. Methods, The present systematic review was performed in line with recommendations of the Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines.

The ten studies included in this analysis were conducted on 1729 patients distributed as 919 patients (53.2%) in the open surgery arm and 810 patients (46.8%) in the RAT arm. Both interventions were comparable regarding duration of surgery, postoperative pain, frequency of intensive care unit (ICU) admission, frequency of postoperative complications, 30-day mortality, hospital readmission, tumor recurrence, 90-day mortality and overall mortality. Patients submitted to RAT had lower intraoperative blood loss [mean difference (95% CI): 185.24 (58.08-312.39)], shorter duration of chest drainage [mean difference (95% CI): 1.52 (1.43-1.60)], lower frequency of major postoperative complications [Risk Ratio (95% CI): 2.01 (1.18-3.42)], shorter duration of hospital stay [mean difference (95% CI): 2.31 (1.87-2.75)] and lower frequency of adjuvant radiotherapy [Risk Ratio (95% CI): 1.63 (1.09-2.44)].

Patients submitted to RAT experienced lower intraoperative blood, shorter duration of chest drainage, lower frequency of major postoperative complications, shorter duration of hospital stay, and lower frequency of adjuvant radiotherapy.