Thoracic Surgery Division, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
J Thorac Cardiovasc Surg. 2012 Nov;144(5):1125-30. doi: 10.1016/j.jtcvs.2012.07.082. Epub 2012 Aug 31.
Minimally invasive thymectomy for stage I to stage II thymoma has been suggested in recent years and considered technically feasible. However, because of the lack of data on long-term results, controversies still exist on surgical access indication. We sought to evaluate the results after robot-assisted thoracoscopic thymectomy in early-stage thymoma.
Data were collected from 4 European centers. Between 2002 and 2011, 79 patients (38 men and 41 women; median age, 57 years) with early-stage thymoma were operated by left-sided (82.4%), right-sided (12.6%), or bilateral (5%) robotic thoracoscopic approach. Forty-five patients (57%) had associated myasthenia gravis.
Average operative time was 155 minutes (range, 70-320 minutes). One patient needed open conversion, in 1 patient a standard thoracoscopy was performed after robotic system breakdown, and in 5 patients an additional access was required. No vascular and nervous injuries were recorded, and no perioperative mortality occurred. Ten patients (12.7%) had postoperative complications. Median hospital stay was 3 days (range, 2-15 days). Median diameter of tumor resected was 3 cm (range, 1-12 cm), and Masaoka stage was stage I in 30 patients (38%) and stage II in 49 patients (62%). At a median follow-up of 40 months, 74 patients were alive and 5 had died (4 patients from nonthymoma-related causes and 1 from a diffuse intrathoracic recurrence), with a 5-year survival rate of 90%.
Our data indicate that robot-enhanced thoracoscopic thymectomy for early-stage thymoma is a technically sound and safe procedure with a low complication rate and a short hospital stay. Oncologic outcome seems good, but a longer follow-up is needed to consider this as a standard approach definitively.
近年来，微创胸腺切除术已被推荐用于 I 期至 II 期胸腺瘤，并被认为在技术上是可行的。然而，由于缺乏长期结果的数据，手术适应证仍存在争议。我们旨在评估机器人辅助胸腔镜胸腺切除术治疗早期胸腺瘤的结果。
数据来自 4 个欧洲中心。2002 年至 2011 年间，79 例（38 名男性和 41 名女性；中位年龄 57 岁）早期胸腺瘤患者接受了左侧（82.4%）、右侧（12.6%）或双侧（5%）机器人胸腔镜入路手术。45 例（57%）合并重症肌无力。
平均手术时间为 155 分钟（70-320 分钟）。1 例患者需要中转开胸，1 例因机器人系统故障改为标准胸腔镜手术，5 例患者需要额外入路。无血管和神经损伤，无围手术期死亡。10 例（12.7%）发生术后并发症。中位住院时间为 3 天（2-15 天）。中位切除肿瘤直径为 3cm（1-12cm），Masaoka 分期 I 期 30 例（38%），II 期 49 例（62%）。中位随访 40 个月时，74 例患者存活，5 例死亡（4 例死于非胸腺瘤相关原因，1 例死于弥漫性胸内复发），5 年生存率为 90%。
我们的数据表明，机器人增强胸腔镜胸腺切除术治疗早期胸腺瘤是一种技术可靠、安全的方法，并发症发生率低，住院时间短。肿瘤学结果似乎良好，但需要更长的随访时间才能将其视为标准方法。
