Comparison of Video-assisted Thoracoscopic Surgery and Median Sternotomy Approaches for Thymic Tumor Resections at a Single Institution

Purpose: This study was designed to evaluate the feasibility and safety of video-assisted thoracoscopic surgery (VATS), and to compare the surgical results of VATS with the standard median sternotomy (MS) approach.

Materials And Methods: Between April 2010 and April 2012, the data of 245 patients who underwent thymectomy for thymic tumors were prospectively collected. Among them, 93 patients with clinical stage I-II disease were retrospectively reviewed.

Results: Resection was planned for VATS in 49 cases, and for MS in 44 cases. During operation, there were 3 conversions to open surgery because of local invasion (conversion to thoracotomy in 1 patient, and sternotomy in 2). No transfusion was required in any patient. There was no significant difference in duration or amount of postoperative chest tube drainage between the 2 groups (P>0.05). Operative time, blood loss during operation, average length of the intensive care unit stay, and length of hospital stay were significantly less in the VATS group than the MS group (P<0.05). There were no major perioperative complications or mortality. No recurrence was detected during a median follow-up of 27 months (range, 12 to 36 mo).

Conclusions: VATS thymectomy for early-stage thymic tumors is safe and feasible. In comparison with standard MS, the VATS approach was associated with a shorter intensive care unit stay and hospital stay. Prospective randomized multi-institutional trials with long-term follow-up are needed to compare the oncological outcomes.