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Transsternal versus Robotic Thymectomy for Thymoma: Feasibility and Results
Ian Paul, Kay See Tan, Joe Dycoco, Prasad Adusumilli, Manjit S. Bains, Matthew J. Bott, James Huang, David R. Jones, Valerie W. Rusch, Bernard J. Park.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.

OBJECTIVE: Minimally invasive approaches to isolated thymic lesions are becoming more common, but there are few data comparing robotic with transsternal thymectomy for the treatment of isolated thymoma. We reviewed our experience to assess feasibility and oncologic outcomes of the robotic approach.
METHODS: This is an institutional review board approved, single center retrospective cohort study comparing patients having thymectomy by sternotomy versus robotic approach for Masaoka stage I-III thymoma. Perioperative outcomes and follow-up were recorded prospectively. Survival estimates and statistical comparisons were calculated using standard software.
RESULTS: From 2004 to 2014, 87 patients underwent thymectomy for Masaoka stage I-III thymoma (46 by median sternotomy, 41 by robotic approach). Median age was lower in the robotic group (60 vs 65 years, p=0.04). There were no differences between groups with respect to gender, BMI, Masaoka stage, and WHO histological subtype. Conversion rate in the robotic group was 4.9% (2 of 41), both due to extensive pleural adhesions. R0 resection rate was equivalent (100% robotic, 96% median sternotomy). Estimated blood loss was less in the robotic group (50 vs 150ml p<0.0001), but procedure duration was higher for robotic group (3h vs 2h, p=0.002). There were no differences in complication rates. Length of hospital stay was significantly shorter in the robotic group (2 vs 4 days, p<0.0001). There was 1 perioperative death in the sternotomy cohort secondary to pulmonary embolism. Median follow-up was 27.1 months vs 61.5 months for robotic vs median sternotomy groups. Zero recurrences were identified in either group.
CONCLUSIONS: Robotic thymectomy for isolated thymoma is safe, achieving similar rates of complete resection and perioperative outcomes with sternotomy. While operative time was longer, length of stay and estimated blood loss were significantly lower in patients undergoing a robotic approach. Interim follow up suggests oncologic outcome is thus far acceptable.

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