Meta-analysis of Subxiphoid Approach Versus Lateral Approach for Thoracoscopic Thymectomy

Overview

Journal J Cardiothorac Surg

Publisher Biomed Central

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2020 May 14

PMID 32398115

Citations 16

Authors

Jiaduo Li

Guoyan Qi

Yaling Liu

Xuguang Zheng

Xiaohe Zhang

Affiliations

Soon will be listed here.

Abstract

Background: Compared with traditional open surgery for thymectomy, video-assisted thoracoscopic surgery (VATS) reduces hospital stay, decreases postoperative pain, and recovers faster. VATS has become increasingly popular in the past decade. VATS techniques to perform a thymectomy include subxiphoid video-assisted thoracoscopic surgery (SVATS) or lateral video-assisted thoracoscopic surgery (LVATS). In this study, our objective was to systematically review on VATS thymectomy and draw a meta-analysis on the outcomes between the two approaches.

Methods: We searched online databases and identified studies from database inception to 2019 that compared SVATS to LVATS thymectomy. Study endpoints included operative time, operative blood loss, length of hospital stay, postoperative pleural drainage, postoperative complications, conversion to open, oncologic outcomes.

Results: Four hundred seventy-one patients were included in this study, for which 200 and 271 patients underwent SVATS and LVATS thymectomy, respectively. Patients in the SVATS group had significantly less operative time, operative blood loss, length of hospital stay, and postoperative complications were identified. There was no statistical difference in postoperative pleural drainage, conversion to open and oncologic outcomes. No hospital deaths were recorded for either procedure.

Conclusions: While randomized controlled studies are required to make definitive conclusions, this meta-analysis suggests that SVATS thymectomy is safe and can achieve good and safe operative and perioperative outcomes similar or better to LVATS thymectomy.

Citing Articles

Minimally invasive thymectomy for patients with thymoma: surgical, oncological and neurological outcomes.

Kumar A, Mittal S, Parshad R, Bhattacharjee H, Suhani , Sharma R Indian J Thorac Cardiovasc Surg. 2024; 41(1):18-26.

PMID: 39679093 PMC: 11638431. DOI: 10.1007/s12055-024-01761-2.

Initial results of uniportal and robot-assisted subxiphoid thymectomy.

Negi T, Morota M, Tochii D, Tochii S, Suda T J Thorac Dis. 2024; 16(10):6778-6788.

PMID: 39552884 PMC: 11565321. DOI: 10.21037/jtd-24-914.

Subxiphoid video-assisted thoracoscopic extend thymectomy with sternal suspension for thymoma.

Jia B, Chen C, Gong T, Zhang Z, Sun B Thorac Cancer. 2024; 15(30):2185-2192.

PMID: 39278840 PMC: 11496188. DOI: 10.1111/1759-7714.15449.

Subxiphoid Single-Port Robotic Thymectomy Using the Single-Port Robotic System versus VATS: A Multi-Institutional, Retrospective, and Propensity Score-Matched Study.

Lee J, Hwang J, Park T, Gu B, Jung Y, Yi E Cancers (Basel). 2024; 16(16).

PMID: 39199627 PMC: 11353098. DOI: 10.3390/cancers16162856.

A proof-of-concept study: advantages of the subxiphoid over the lateral intercostal approach.

He G, Yao T, Zhao L, Geng H, Ji Q, Zuo K Interdiscip Cardiovasc Thorac Surg. 2024; 38(5).

PMID: 38632049 PMC: 11112048. DOI: 10.1093/icvts/ivae067.

References

Ye B, Li W, Ge X, Feng J, Ji C, Cheng M . Surgical treatment of early-stage thymomas: robot-assisted thoracoscopic surgery versus transsternal thymectomy. Surg Endosc. 2013; 28(1):122-6. DOI: 10.1007/s00464-013-3137-7. View

Nesher N, Pevni D, Aviram G, Kramer A, Mohr R, Uretzky G . Video-assisted thymectomy with contralateral surveillance camera: a means to minimize the risk of contralateral phrenic nerve injury. Innovations (Phila). 2012; 7(4):266-9. DOI: 10.1097/IMI.0b013e3182742a53. View

Hsu C, Chuang C, Hsu N, Chen C . Comparison between the right side and subxiphoid bilateral approaches in performing video-assisted thoracoscopic extended thymectomy for myasthenia gravis. Surg Endosc. 2004; 18(5):821-4. DOI: 10.1007/s00464-003-9146-1. View

Yu L, Zhang X, Ma S, Li F, Zhang Y . Thoracoscopic thymectomy for myasthenia gravis with and without thymoma: a single-center experience. Ann Thorac Surg. 2011; 93(1):240-4. DOI: 10.1016/j.athoracsur.2011.04.043. View

Lu Q, Zhao J, Wang J, Chen Z, Han Y, Huang L . Subxiphoid and subcostal arch "Three ports" thoracoscopic extended thymectomy for myasthenia gravis. J Thorac Dis. 2018; 10(3):1711-1720. PMC: 5906355. DOI: 10.21037/jtd.2018.02.11. View

Hozo S, Djulbegovic B, Hozo I . Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5:13. PMC: 1097734. DOI: 10.1186/1471-2288-5-13. View

Yano M, Moriyama S, Haneda H, Okuda K, Kawano O, Oda R . The Subxiphoid Approach Leads to Less Invasive Thoracoscopic Thymectomy Than the Lateral Approach. World J Surg. 2016; 41(3):763-770. DOI: 10.1007/s00268-016-3783-8. View

Tomulescu V, Sgarbura O, Stanescu C, Valciu C, Campeanu A, Herlea V . Ten-year results of thoracoscopic unilateral extended thymectomy performed in nonthymomatous myasthenia gravis. Ann Surg. 2011; 254(5):761-5. DOI: 10.1097/SLA.0b013e31823686f6. View

Suda T . Single-port thymectomy using a subxiphoid approach-surgical technique. Ann Cardiothorac Surg. 2016; 5(1):56-8. PMC: 4740101. DOI: 10.3978/j.issn.2225-319X.2015.08.02. View

10.

Chen H, Xu G, Zheng W, Chen C . Video-assisted thoracoscopic extended thymectomy using the subxiphoid approach. J Vis Surg. 2017; 2:157. PMC: 5638370. DOI: 10.21037/jovs.2016.09.02. View

11.

Zhang L, Li M, Jiang F, Zhang Z, Zhang Q, Xu L . Subxiphoid versus lateral intercostal approaches thoracoscopic thymectomy for non-myasthenic early-stage thymoma: A propensity score -matched analysis. Int J Surg. 2019; 67:13-17. DOI: 10.1016/j.ijsu.2019.01.011. View

12.

Suda T, Sugimura H, Tochii D, Kihara M, Hattori Y . Single-port thymectomy through an infrasternal approach. Ann Thorac Surg. 2011; 93(1):334-6. DOI: 10.1016/j.athoracsur.2011.08.047. View

13.

Suda T, Hachimaru A, Tochii D, Maeda R, Tochii S, Takagi Y . Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: initial results†. Eur J Cardiothorac Surg. 2015; 49 Suppl 1:i54-8. DOI: 10.1093/ejcts/ezv338. View

14.

Yu L, Ma S, Jing Y, Zhang Y, Li F, Krasna M . Combined unilateral-thoracoscopic and mediastinoscopic thymectomy. Ann Thorac Surg. 2010; 90(6):2068-70. DOI: 10.1016/j.athoracsur.2010.02.042. View

15.

Suda T, Ashikari S, Tochii D, Tochii S, Takagi Y . Dual-port thymectomy using subxiphoid approach. Gen Thorac Cardiovasc Surg. 2013; 62(9):570-2. DOI: 10.1007/s11748-013-0337-y. View