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Monocentric Evaluation Of Surgical And Oncological Outcomes Of Locally Advanced Thymic Tumours: Robotic Vs Open Surgery
Fabrizia Calabrò, Cristina Carmelina Zirafa, Gaetano Romano, Federico Davini, elisa sicolo, Riccardo Morganti, Franca Melfi;
University of Pisa, Pisa, Italy
BACKGROUND:Thymic malignancies are rare diseases. While treatment for the early stage is well established in the guidelines, the therapy for locally advanced and metastatic neoplasm (Masaoka stage IVa/IVb) is not universally established. Surgery remains the gold standard, integrated into a multidisciplinary approach in stage III-IV tumours, and radical surgical resection is considered the most important prognostic factor. Currently, open surgery is still the surgical approach of choice in the most advanced stages.
This study aims to compare the short-term and long-term results of patients with locally advanced thymic tumours who underwent robotic and open surgery
METHODS:In this retrospective study, 41 patients who underwent extended thymectomy for thymic tumour with radical intent (R0), from March 2011 to August 2021, were enrolled:-29 (71%): open approach (6 thoracotomy, 11 sternotomy, 2 hemiclamshell)-12 (29%): robotic approachPatient characteristics and postoperative outcomes were investigated.Specially, we analyzed: - perioperative results: myasthenia gravis (MG) diagnosis, operating time, length of hospital stay, complication rate - oncological results: disease-free survival (DFS), overall survival (OS)
RESULTS:A statistically significant shorter length of stay was observed in robotic patients. No difference was recorded in terms of intra and postoperative complications. No statistically significant differences were found in the evaluation of DFS and OS between robotic and open surgery.
Furthermore, stage IV and adjuvant chemotherapy were negative prognostic factor for DFS, while thymic carcinoma and stage IV was negative prognostic factor for OS. MG didn’t seem to be a negative prognostic factor for OS and DFS
CONCLUSIONS:Radical surgery in the locally advanced thymic tumour is associated with a favourable prognosis. Robotic thymectomy is associated with faster recovery when compared to open surgery, and comparable oncological outcomes in stage III and IV thymic tumours
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