Robot-aided thoracoscopic thymectomy for early-stage thymoma: A multicenter European study

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 144; no. 5; pp. 1125 - 1132
• Main Authors: Marulli, Giuseppe, Rea, Federico, Melfi, Franca, Schmid, Thomas A., Ismail, Mahmoud, Fanucchi, Olivia, Augustin, Florian, Swierzy, Marc, Di Chiara, Francesco, Mussi, Alfredo, Rueckert, Jens C.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.11.2012; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Europe; Female; Humans; Kaplan-Meier Estimate; Length of Stay; Male; Medical sciences; Middle Aged; Neoplasm Staging; Neoplasms, Glandular and Epithelial - diagnostic imaging; Neoplasms, Glandular and Epithelial - mortality; Neoplasms, Glandular and Epithelial - pathology; Neoplasms, Glandular and Epithelial - surgery; Pneumology; Postoperative Complications - etiology; Postoperative Complications - therapy; Retrospective Studies; Robotics; Surgery, Computer-Assisted - adverse effects; Surgery, Computer-Assisted - mortality; Thoracic Surgery, Video-Assisted - adverse effects; Thoracic Surgery, Video-Assisted - mortality; Thymectomy - adverse effects; Thymectomy - methods; Thymectomy - mortality; Thymus Neoplasms - diagnostic imaging; Thymus Neoplasms - mortality; Thymus Neoplasms - pathology; Thymus Neoplasms - surgery; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Tumors of the respiratory system and mediastinum; Young Adult; Europe; 13; VATS; MG; 28; myasthenia gravis; video-assisted thoracoscopic surgery; Thymoma; Mediastinum disease; Multicenter study; Early stage; Malignant tumor; European; Thymus pathology; Thymectomy; Treatment; Surgery; Anesthesia; Thymic epithelial tumor; Benign neoplasm; Circulatory system; Cardiology; Robot; Cancer
• ISSN: 0022-5223; 1097-685X; 1097-685X
• DOI: 10.1016/j.jtcvs.2012.07.082

Minimally invasive thymectomy for stage I to stage II thymoma has been suggested in recent years and considered technically feasible. However, because of the lack of data on long-term results, controversies still exist on surgical access indication. We sought to evaluate the results after robot-assisted thoracoscopic thymectomy in early-stage thymoma. Data were collected from 4 European centers. Between 2002 and 2011, 79 patients (38 men and 41 women; median age, 57 years) with early-stage thymoma were operated by left-sided (82.4%), right-sided (12.6%), or bilateral (5%) robotic thoracoscopic approach. Forty-five patients (57%) had associated myasthenia gravis. Average operative time was 155 minutes (range, 70-320 minutes). One patient needed open conversion, in 1 patient a standard thoracoscopy was performed after robotic system breakdown, and in 5 patients an additional access was required. No vascular and nervous injuries were recorded, and no perioperative mortality occurred. Ten patients (12.7%) had postoperative complications. Median hospital stay was 3 days (range, 2-15 days). Median diameter of tumor resected was 3 cm (range, 1-12 cm), and Masaoka stage was stage I in 30 patients (38%) and stage II in 49 patients (62%). At a median follow-up of 40 months, 74 patients were alive and 5 had died (4 patients from nonthymoma-related causes and 1 from a diffuse intrathoracic recurrence), with a 5-year survival rate of 90%. Our data indicate that robot-enhanced thoracoscopic thymectomy for early-stage thymoma is a technically sound and safe procedure with a low complication rate and a short hospital stay. Oncologic outcome seems good, but a longer follow-up is needed to consider this as a standard approach definitively.