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Minimally invasive thymectomy and open thymectomy: outcome analysis of 263 patients.

BACKGROUND: An open thymectomy is a morbid procedure. If a minimally invasive thymectomy is performed without compromising the tenets of thymic surgery, it has the potential for decreasing morbidity and may offer similar clinical and oncologic results.

METHODS: This is an institutional review board-approved, retrospective study of a single center's experience with both open (transsternal) and minimally invasive (video-assisted thoracoscopic surgery) thymectomy. Survival estimates and statistical comparisons were calculated using standard software.

RESULTS: From 2000 to 2011, 263 patients (93 men; median age, 49 years; interquartile range, 37 to 60 years) underwent thymectomy for indications including myasthenia gravis (n = 139) and mediastinal mass (n = 108). Seventy-seven thymectomies were performed by minimally invasive approach. Both groups were equally stratified by sex, body mass index, World Health Organization and Masaoka-Koga staging, incidence of myasthenia gravis, and comorbidities except hyperlipidemia and diabetes. The minimally invasive thymectomy cohort had significantly shorter hospital (p < 0.01) and intensive care unit lengths of stay (p < 0.01) and a lower estimated blood loss (p < 0.01). There was an insignificant difference in postoperative cardiac and respiratory complication rates as well as vocal cord paralysis (p = 0.60). There was no difference in terms of operative room times (p = 0.88) or volume of blood products transfused (p = 0.16) between the two groups. Higher estimated blood loss was associated with higher intensive care unit admission rates (p < 0.01). All minimally invasive thymoma resections were complete, with negative margins.

CONCLUSIONS: Minimally invasive thymectomy is safe and achieves a comparable resection and postoperative complication profile when used selectively for all indications, including myasthenia gravis and small thymomas without vascular invasion.

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