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Video-assisted thoracoscopic versus open surgery for early-stage thymoma: a comparative analysis of surgical outcomes
Seung Ku Kang1, Ju Sik Yun1, Kook Joo Na2, Sang Yun Song2.
1Chonnam National University Hospital, Gwangju, Korea, Republic of, 2Chonnam National University Hwasun Hospital, Jeollanamdo, Korea, Republic of.

OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) may be used for resection of various mediastinal tumors. However, a VATS approach for thymoma is still controversial. The objective of this study was to compare the VATS and open surgery to see whether VATS thymectomy could be used as successfully to treat early-stage thymoma.
METHODS: Between 2002 and 2011, we retrospectively reviewed 58 patients (29 males and 29 females) with early-stage (Masaoka stage I, II) thymoma who underwent thymectomy in our institution. All of the patients had no associated myasthenia gravis. Of these, VATS was peformed in 30 patients (the VATS group) and Open (trans-sternal) surgery was performed in 28 patients (the open group). Demographic and clinical features, surgical outcomes were analyzed.
RESULTS: Mean age was 53.0 ± 13.9 years (range, 11 to 77 years). Among the VATS group, 17 patients were operated by right-sided (56.7%), and the others were operated by left-sided (43.3%). One patient in the VATS group required conversion to posterolateral thoracotomy because of severe adhesion between the tumor and the mediastinal pleura which mimicked invasion to the lung. There was no in-hospital mortality. The difference between the VATS and open groups in mean age (51.7 ± 14.1 years vs 54.5 ± 13.9, p=0.456); male:female ratio (13:17 vs 16:12, p=0.431); morbidity (3.4% vs 10.3%, p=0.138) were not statistically significant. However, mean tumor size (4.7 ± 1.5 cm vs 7.1 ± 2.5 cm, p < 0.001), mean operation time (79.7 ± 29.8 min vs 129.8 ± 35.9 min, p < 0.001) and mean duration of postoperative hospital stay (3.7 ± 2.4 days vs 9.3 ± 3.2 days, p < 0.001) were significantly different. During the follow-up period, none of the patients died from thymoma-related causes. And there was no difference in recurrence rate between the two groups (10.0% vs 10.7%, p=1.000).
CONCLUSIONS: Our data indicate that VATS thymectomy for early-stage thymoma is technically feasible and can produce satisfactory surgical outcomes. But, further investigation with long-term follow-up is needed.


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