AB043. Comparative analysis of surgical approaches and optimal resection extent in thymoma treatment
Original Research

AB043. Comparative analysis of surgical approaches and optimal resection extent in thymoma treatment

Yi Zhang1, Gaojun Lu1, Kejian Shi1, Xin Zhao1, Hao Cui1, Ku Zhang2

1Thoracic Surgery Department, Xuanwu Hospital, Capital Medical University, Beijing, China; 2Department of Thoracic Surgery, Tangdu Hospital of Air Force Medical University, Xi’an, China

Correspondence to: Yi Zhang, MD. Thoracic Surgery Department, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing 100032, China. Email: zhangyixwhosp@xwh.ccmu.edu.cn.

Background: The optimal minimally invasive surgical approach and resection extent for thymoma remain controversial. This study aims to evaluate the prognostic impact and safety profiles of different surgical approaches and resection extents in thymoma management.

Methods: A retrospective cohort analysis included patients undergoing thymectomy for thymoma at Xuanwu Hospital, Capital Medical University (January 2014–March 2021). Patients were stratified by surgical approach and resection extent. Clinical outcomes, operative parameters, complications, and long-term follow-up data were analyzed.

Results: Among 209 patients, surgical approaches included unilateral intercostal (n=134, 64.1%), subxiphoid (n=53, 25.4%), and bilateral intercostal (n=22, 10.5%). Baseline characteristics were comparable across groups. The subxiphoid approach demonstrated superior outcomes, including reduced intraoperative blood loss, shorter postoperative hospitalization, lower complication rates, and no chest tube drainage. Although subxiphoid and bilateral intercostal approaches initially required longer operative times, surgical efficiency improved with surgeon experience. Both subxiphoid and bilateral intercostal approaches demonstrated similar rates of ectopic thymic tissue identification. In subclinical myasthenia gravis patients (asymptomatic thymoma with seropositivity for pathogenic antibodies), extended thymectomy demonstrated equivalent perioperative safety to conventional thymectomy. Long-term follow-up demonstrated that extended thymectomy significantly reduced the risk of neurological symptom recurrence in subclinical myasthenia gravis patients.

Conclusions: The subxiphoid approach optimizes perioperative recovery as a minimally invasive strategy, while extended thymectomy improves neurological outcomes in subclinical myasthenia gravis. These findings underscore the importance of tailored surgical strategies in thymoma management.

Keywords: Thymoma; surgical approach; extended thymectomy; surgical outcomes

Acknowledgments

None.

Footnote

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-ab043/coif). The 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 Ethics Committee of Xuanwu Hospital (IRB # [2022] 057) 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-ab043
Cite this abstract as: Zhang Y, Lu G, Shi K, Zhao X, Cui H, Zhang K. AB043. Comparative analysis of surgical approaches and optimal resection extent in thymoma treatment. Mediastinum 2025;9:AB043.

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