Original Research
AB001. Robot-assisted thoracic surgery for thymic epithelial tumors: a real-world study of 143 cases
Benedikt Niedermaier1,2, Nabil Khan1, Florian Eichhorn1,2, Heidrun Grosch3, Petros Christopoulos2,3, Michael Thomas2,3, Hauke Winter1,2, Martin Eichhorn1,2
1Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany;
2Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany;
3Department of Oncology, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany
Correspondence to: Benedikt Niedermaier, MD. Department of Thoracic Surgery, Thoraxklinik at the University Hospital Heidelberg, Röntgenstr. 1, Heidelberg, 69120, Germany. Email: benedikt.niedermaier@med.uni-heidelberg.de.
Background: Robot-assisted thoracoscopy (RATS) is rapidly emerging as the preferred approach for the resection of thymic epithelial tumors (TETs). Current challenges include exploring the significance of RATS in locally advanced disease and maximum resectable tumor size. The purpose of this article is to analyze perioperative results and findings from a large center for robot-assisted surgery.
Methods: This single-center analysis was conducted on the basis of a prospectively assembled database including all robot-assisted surgeries. Patients’ medical and surgical records as well as radiologic and pathologic findings were reviewed and analyzed.
Results: One hundred forty-three patients underwent RATS for the resection of histologically confirmed TET between 2018 and 2024, including 130 (90.9%) patients with thymoma and 13 (9.1%) patients with thymic carcinoma. Concomitant myasthenia gravis was present in 28 (19.6%) patients. The median tumor size was 54 mm [interquartile range (IQR), 35.5–75 mm]. Masaoka-Koga stage I was diagnosed in 63 patients (44.1%), stage II in 39.9%, stage III in 11.2% and stage IV in 4.9%. The median operating time was 96.5 min (IQR, 81–152 min). Combined additional resections including lung, pericardium or major vessels were performed in 44 (30.8%) patients. Controlled conversion occurred in 6 patients (4.2%) without any emergency conversion. R0 resection was achieved in 134 (93.7%) patients. The median postoperative stay was 4 days (IQR, 3–6 days) with a median duration of chest tube of 2 days (IQR, 1–3 days). Postoperative complications occurred in 28 (19.6%) patients, of which 7 (4.9%) were classified as major complications according to Clavien-Dindo grade III–IV. Postoperative complications occurred significantly more frequently in patients who also underwent resection of lung tissue, vessels or pericardium [odds ratio (OR) =2.87; 95% confidence interval (CI): 1.09–7.58; P=0.03]. Concomitant autoimmune disease or tumor size over 50 mm did not predict complications. There was no 90-day mortality. Median follow-up time was 16.1 months with 94.3% recurrence-free survival at 2 years.
Conclusions: Robot-assisted resection of thymic epithelial tumors is feasible and safe. Combined additional resections are a significant predictor of postoperative complications. In view of the challenges posed by locally advanced TET, collaborative efforts should be encouraged to facilitate multicenter cooperation and generate robust evidence on RATS in this context.
Keywords: Thymoma; robotic; surgery
Acknowledgments
None.
Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-25-ab001/coif). M.E. and H.W. report speaker fees and proctoring for Intuitive Surgical, as well as financial support for the research initiative “Robotic-assisted thoracic surgery: impact on clinical and economic outcomes in a high volume European Thoracic Surgery Center” by Intuitive Surgical outside of the submitted work. The other authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the institutional ethics committee of Heidelberg University (S-089/2018) and individual consent for this retrospective analysis was waived.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
doi: 10.21037/med-25-ab001
Cite this abstract as: Niedermaier B, Khan N, Eichhorn F, Grosch H, Christopoulos P, Thomas M, Winter H, Eichhorn M. AB001. Robot-assisted thoracic surgery for thymic epithelial tumors: a real-world study of 143 cases. Mediastinum 2025;9:AB001.
