AB029. Short-term outcomes of uniportal subxiphoid thoracoscopic thymectomy for anterior mediastinal tumors
Abstract

AB029. Short-term outcomes of uniportal subxiphoid thoracoscopic thymectomy for anterior mediastinal tumors

Shuai Wang1,2, Yuansheng Zheng1,2, Jiahao Jiang1,2, Yongqiang Ao1,2, Jian Gao1,2, Fei Liang2,3, Yuanyuan Ma4, Jianyong Ding1,2

1Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; 2Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China; 3Clinical Statistics Center, Zhongshan Hospital, Fudan University, Shanghai, China; 4Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China

Correspondence to: Shuai Wang, PhD. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China. Email: wang.shuai@zs-hospital.sh.cn.

Background: This study reports the short-term clinical outcomes of uniportal subxiphoid thoracoscopic thymectomy (USTT) for anterior mediastinal tumors.

Methods: Consecutive patients without myasthenia gravis who underwent USTT from June 2023 to May 2024 were prospectively enrolled in this study. USTT was accomplished through a single transverse incision below the lower edge of the xiphoid for treatment of thymic tumor using an auxiliary sternal retractor to create a larger operative field. Surgical difficulty was evaluated by a modified resection index. Clinicopathological characteristics and perioperative outcomes were analyzed.

Results: A total of 109 patients receiving USTT were included in this study. There were 45 males and 64 females with a median age of 55 years. According to World Health Organization (WHO) histological classification, there were 2 of hemangioma, 10 of type A, 25 of type AB, 14 of type B1, 21 of type B2, 10 of type B2+B3, 12 of type B3, 2 of neuroendocrine thymic tumor (G2) and 13 of thymic squamous carcinoma. The median tumor size was 3.7 (range, 1.5–8.0) cm and 41 cases had locally invasive behavior, invaded mediastinal fat (28 cases), pleura (6 cases), pericardium (9 cases), phrenic nerve (4 cases), and lung (12 cases). The median number of lymph node resection station and removed lymph nodes was 1.0 and 2.0. None of them had pathological metastatic lymph nodes. Pathological 9th tumor-node-metastasis (TNM) staging revealed 89 with stage I (81.7%), and 20 with stage II disease (18.3%). The mean modified resection index was 3.5. Complete resection was achieved in all patients and there were no conversions to sternotomy. The median operation time was 75 minutes with the median blood loss of 30 mL. The median duration of chest tube placement and postoperative hospital stay was 1.0 and 2.0 days. None had serious complications (≥ grade 3) or mortality during the perioperative period. Eight patients underwent postoperative adjuvant radiotherapy without chemotherapy and presented no local recurrence or distant metastasis until now.

Conclusions: The USTT was safe and effective for thymic tumors and could be an alternative for selected patients with locally advanced thymic diseases. Further prospective studies are needed to evaluate the long-term oncological results of USTT.

Keywords: Uniport; thymectomy; subxiphoid; thymoma


Acknowledgments

Funding: None.


Footnote

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-24-ab029/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 (as revised in 2013). This study was approved by the Ethics Committee of the Zhongshan Hospital of Fudan University (No. B2022-419) and informed consent was obtained from all individual participants.

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-24-ab029
Cite this abstract as: Wang S, Zheng Y, Jiang J, Ao Y, Gao J, Liang F, Ma Y, Ding J. AB029. Short-term outcomes of uniportal subxiphoid thoracoscopic thymectomy for anterior mediastinal tumors. Mediastinum 2024;8:AB029.

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