Outcomes Of Robotic Assisted Anterior Mediastinal Resections For Large Primary Thymic Tumors: A Single Institution Experience
Abigail Fong, Inderpal Sarkaria, Nicholas Baker, Neil Christie, Rajeev Dhupar, Ryan M. Levy, Omar Awais, Tadeusz Witek, Alicuben T. Evan, James D. Luketich, Arjun Pennathur, Matthew Schuchert.
UPMC, Pittsburgh, PA, USA.
BACKGROUND: This study seeks to describe our large series of robotic mediastinal resections and investigate the safety and efficacy of this surgical modality in both small and large primary thymic malignancies.
METHODS: A retrospective review was performed of robotic assisted anterior mediastinal resections in our institution from 2014-2022. Data was gathered on these patients including demographics and perioperative outcomes. Data was stratified by pathologic diagnosis and a group of primary thymic malignancies was identified and outcomes compared by tumor size. Statistical analysis was performed using chi-squared, fisher exact test and T-tests to compare samples as appropriate.
RESULTS: 234 robotic assisted anterior mediastinal resections were performed during the time frame of the study. Of these, 130 (56%) were performed for benign disease, 104 (44%) for malignant disease. The most common malignant diagnoses were thymoma (61, 26%), metastatic disease (14, 6%), lymphoma (9, 3.8%) and thymic squamous cell carcinoma (6, 2.6%). The overall median length of stay was 2 days, and median operative time was 178 minutes. 66 were found to be primary thymic malignancies. Of these, the average tumor size was 5.6cm, median hospital stay was 3 days and median operative time was 186 minutes. When comparing our primary thymic malignancies larger than 4cm (44,67%) vs =<4cm (22, 33%), those >4cm were found to have a longer average operative time (227 vs 172 minutes, p=0.04), but no difference in average length of stay (6.9 days vs 5.5 days, p=0.69) or Clavien-Dindo grade III-V complication rate (3 grade III/IV vs 1 grade III/IV and 1 grade V, p=0.18). In the >4cm primary thymic malignancy group 39 (89%) R0 resections were seen, compared to 22 (100%) R0 resections in the =<4cm group (p=0.15), showing no significant difference. Of note 16 of the thymic malignancy group ranged in size from 7-14cm with negative margins.
CONCLUSIONS: Robotic mediastinal resections can be safe and effective, even in large primary thymic malignancies > 7cm, although some concern regarding greater rates of margin positivity in these tumors remains. Further work is necessary to identify factors potentially predicting positive margins in these patients.
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