To compare post-operative outcomes associated with thymectomy performed using either
open or robotic approaches. Retrospective cohort study from a single-center prospective
registry consisting of patients undergoing thymectomy between 2000 and 2020. Patients
were grouped according to surgical approach (open vs robotic). A propensity-score
matching analysis was performed in a 2:1 open to robotic ratio, and surgical outcomes
were evaluated. We analyzed 234 thymectomies (155 open; 79 robotic). Myasthenia gravis
was present in 23.2% and 32.9% (P = 0.249) in the open and in the robotic group, respectively. All covariates were
balanced in the matched groups (open n = 114; robotic n =5 9), except lesion size.
The robotic approach was significantly associated with shorter surgical time (median
95 vs 65 minutes, P < 0.001), lesser clinical (21.1% vs 6.8%, P = 0.016) and surgical (11.4% vs 1.7%, P = 0.036) complications during the same hospitalization, less Clavien-Dindo grade
2 or higher complication rates (28.1 vs 15.3%, P = 0.048), chest tube duration (median: 3 vs 0 days, P < 0.001) and in-hospital length of stay (median: 5 vs 0 days, P < 0.001). Bleeding (P = 0.214), ICU length of stay (P = 0.167), reoperation rate (open, 1.8% vs robotic 0%), 90-day mortality (P = 0.341) and readmission rate post discharge (P = 0.277) were similar between the groups. In the matched population with primary
thymic epithelial tumors, the completeness of resection rate was similar (open, 92.1%
vs robotic 96.8%, P = 0.66.). Robotic thymectomy is associated with improved post-operative outcomes
when compared to open thymectomy, without compromising the goals of oncologic surgery.
Longer follow-up is needed to ensure oncologic equivalence.
Graphical Abstract
Graphical Abstract
Keywords
Abbreviations:
ASA-PS (American Society of Anesthesiologists – Physical Status Classification), BMI (Body Mass Index), CACI (Charlson-Age Comorbidity Index), CAD (Coronary Artery Disease), CHF (Congestive Heart Failure), COPD (Chronic Obstructive Pulmonary Disease), CT (Computed Tomography), ERAS (Enhanced Recovery After Surgery), ICU (Intensive Care Unit), ITMIG (International Thymic Malignancy Interest Group), LOS (Length of Stay), METs (Metabolic Equivalents), MG (Myasthenia Gravis), PET-CT (Positron-Emission Computed Tomography), PSM (Propensity-Score Match), RP (Robotic Portal), SVC (Superior Vena Cava), TET (Thymic Epithelial Tumor), WHO (World Health Organization)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 25, 2021
Footnotes
IRB approval CRCHUM IRB#: 19.252. November 20, 2019
The Institutional Review Board waived the need for informed consent.
Funding: This work was supported by a grant from the Intuitive Foundation Clinical Research Grant Program.
Conflicts of Interest: Stephan A. Soder: none declared; Clare Pollock: none declared; Pasquale Ferraro: none declared; Edwin Lafontaine: none declared; Jocelyne Martin: none declared; Basil Nasir: none declared; Moishe Liberman: none declared.
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- Commentary: Great Outcomes Associated With Robotic Thymectomy –Thank You Very Much Mr RobotSeminars in Thoracic and Cardiovascular SurgeryVol. 35Issue 1
- PreviewIn this most recent issue of Seminars, Dr Soder and colleagues discuss a single institution experience with open and robotic thymectomy over a 20-year time span concluding June 30, 2020. Propensity matched analysis, utilized to compare the open versus robotic thymectomy, revealed that the robotic thymectomy was associated with shorter surgical time, less significant clinical and surgical complications as well as shorter chest tube duration and length of stay when compared with open thymectomy. Eight surgeons performed open thymectomy during the study period whilst a single surgeon performed robotic thymectomy.
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