Kneuertz Peter J, Kamel Mohamed K, Stiles Brendon M, Lee Benjamin E, Rahouma Mohamed, Nasar Abu, Altorki Nasser K, Port Jeffrey L
Department of Cardiothoracic Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York.
Department of Cardiothoracic Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York.
Ann Thorac Surg. 2017 Nov;104(5):1673-1678. doi: 10.1016/j.athoracsur.2017.05.074. Epub 2017 Sep 19.
Robotic-assisted thymectomy (RAT) is increasingly performed for resection of thymomas. Its application for large tumors remains controversial. In this study, we evaluated the safety and feasibility of RAT for large thymomas in comparison with transsternal thymectomy (ST).
A single institution database was reviewed for patients who underwent RAT for thymoma of 4 cm or larger between 2004 and 2016. Propensity scores were applied to match RAT with ST patients, based on age, sex, tumor size, and Masaoka stage. Perioperative outcomes were compared.
Twenty patients (15 women and 5 men, median age 59 years) underwent RAT for a large thymoma (median size 6.0 cm). A right-sided approach was used in 14 patients (70%). A control group of 34 ST patients (median size 6.7 cm) had similar Masaoka staging (p = 0.64). Combined resection of adjacent structures, including pericardium, lung, and phrenic nerve, were frequently performed in both groups (50% RAT versus 47% ST, p = 0.83). RAT patients had lower blood loss (25 mL versus 150 mL, p = 0.001), were more frequently managed with a single chest tube (85% versus 56%, p = 0.027), and had a shorter median length of stay (3 days versus 4 days, p = 0.034). There were no perioperative deaths and no major vascular injuries. Three RAT patients (15%) were converted to open approach. Overall complication rates were similar between RAT and ST patients (15% versus 24%, p = 0.45). No difference was seen in R0 resection rates (90% versus 85%, p = 0.62).
RAT can be performed safely and effectively in a radical fashion for large thymomas. Future studies are necessary to determine long-term oncologic outcomes.
机器人辅助胸腺切除术（RAT）在胸腺瘤切除术中的应用日益增多。其在大型肿瘤中的应用仍存在争议。在本研究中，我们评估了与经胸骨胸腺切除术（ST）相比，RAT治疗大型胸腺瘤的安全性和可行性。
回顾了一家机构的数据库中2004年至2016年间接受RAT治疗4厘米或更大胸腺瘤的患者。根据年龄、性别、肿瘤大小和马萨oka分期，应用倾向评分将RAT患者与ST患者进行匹配。比较围手术期结果。
20例患者（15例女性和5例男性，中位年龄59岁）接受了大型胸腺瘤的RAT治疗（中位大小6.0厘米）。14例患者（70%）采用右侧入路。34例ST患者的对照组（中位大小6.7厘米）马萨oka分期相似（p = 0.64）。两组均经常进行包括心包、肺和膈神经在内的相邻结构的联合切除（RAT组为50%，ST组为47%，p = 0.83）。RAT患者失血量较少（25毫升对150毫升，p = 0.001），更常使用单根胸管（85%对56%，p = 0.027），中位住院时间较短（3天对4天，p = 0.034）。无围手术期死亡和重大血管损伤。3例RAT患者（15%）转为开放手术。RAT组和ST组患者的总体并发症发生率相似（15%对24%，p = 0.45）。R0切除率无差异（90%对85%，p = 0.62）。
RAT可以安全有效地以根治性方式用于大型胸腺瘤。未来有必要进行研究以确定长期肿瘤学结果。
