Early and mid-term outcomes of trans-sternal and video-assisted thoracoscopic surgery for thymoma

OBJECTIVES: Video-assisted thoracoscopic surgery (VATS) for thymoma has uncertain safety and effectiveness in comparison with transsternal resection. This feasibility study compared short- and mid-term outcomes for patients undergoing these two procedures, highlights weaknesses in current research and makes recommendations for long-term technological evaluations in this field. METHODS: Consecutive thymoma cases between 2004 and 2010 were identified. Patients were divided into two groups according to surgical approach (Group I trans-sternal; Group II VATS) and comparisons were made between groups. The primary outcome was overall survival. Secondary outcomes included operative morbidity and mortality, hospital stay, recurrence rate and disease-free survival. RESULTS: Thirty-nine patients were included (Group I: n=22 vs Group II: n=17). There were no differences between groups at baseline for all measured covariates. No deaths occurred within 30 days of surgery. More patients in Group I developed complications (Group I: n=10 vs Group II: n=3;P=0.093), while hospital stay was shorter in Group II (Group I: 6.4±4.6 days vs Group II: 4.4±1.8 days; P=0.030). Five-year overall survival (Group I: 93.8±6.1% vs Group II: 83.3±11.2%; P=0.425), 5-year disease-free survival (Group I: 71.0±15.3% vs Group II: 83.3±11.2%; P=0.827) and recurrence rates at final follow-up (Group I: n=2 vs Group II: n=1;P=0.363) were similar between the groups. CONCLUSION: VATS thymectomy for thymoma is feasible, safe and has comparable mid-term oncological outcomes to trans-sternal thymectomy. Future research is required to evaluate long-term oncological outcomes of VATS thymectomy for thymoma in national registries and randomized, controlled trials.