Aragón Javier, Pérez Méndez Itzell, Gutiérrez Pérez Alexia
Department of Thoracic Surgery, Asturias University Central Hospital, Asturias, Spain.
J Vis Surg. 2016 Mar 30;2:71. doi: 10.21037/jovs.2016.03.07. eCollection 2016.
Although video-assisted thoracoscopic surgery (VATS) for thymic disorders has been introduced, its oncological outcome and benefits over others open approaches remains unclear. Single-port VATS thymectomy using a flexible port and CO has been described. However, VATS thymectomy is possible by a single incision of 3 cm without CO insufflation or special port device avoiding objections related to CO insufflation and allowing instruments to move more freely making procedure easier and cheaper. Our institutional experience in open and CO-less VATS single-port thymectomy was retrospectively reviewed to evaluate compared to sternotomy, the clinical and oncological outcomes with this novel approach.
A retrospective review consisting of 84 patients who underwent thymectomy because different thymic disorders especially thymoma was performed. Eighteen patients underwent CO-less VATS single port thymectomy, while 66 underwent thymectomy through open sternotomy. Many clinical factors associated with the surgical and clinical outcomes, including tumor recurrence and clinical remission, were recorded.
Non major postoperative complications were observed in any group. The median operative time and postoperative hospital stay of CO-less VATS single port thymectomy were 95 min and 1 day, respectively and 120 min and 7 days for open sternotomy. The thymoma was the most common thymic disorder with 7 patients (38%) in VATS group and 28 patients (42.4%) for the open approach. The median lesion size was 2.6 cm in the VATS group and 3.2 cm in the open approach. No thymoma recurrence in patients undergoing VATS was observed during the follow-up time, while in the open surgery group 14.28% recurrence was observed, distributed as follows: loco-regional 75% and 25% at distance; free disease period of these patients was 8.3 months. Thymectomy associated with myasthenia gravis (MG) was observed in 6 (33%) patients in the VATS group and 32 (48%) patients for sternotomy; our results regarding thymectomy for the treatment of MG were established by the MG post-intervention status [complete stable remission (CSR), pharmacologic remission, minimal manifestations, improved, unchanged and worse exacerbation, and died of MG] and reflected similar results in both approaches.
CO-less VATS single-port thymectomy is a feasible and safe procedure. Oncologic outcomes are similar to open approaches. Complications, surgical time and hospital stay are shorter compared with sternotomy. This is an initial experience, further work is required to evaluate long-term results.
尽管已引入用于胸腺疾病的电视辅助胸腔镜手术（VATS），但其肿瘤学结局以及相较于其他开放手术方法的优势仍不明确。已有使用可弯曲端口和二氧化碳（CO）进行单孔VATS胸腺切除术的描述。然而，不使用CO充气或特殊端口装置，通过3厘米的单一切口进行VATS胸腺切除术也是可行的，这样可以避免与CO充气相关的问题，并使器械移动更自由，使手术更简便且成本更低。我们回顾性分析了本机构在开放手术和无CO的VATS单孔胸腺切除术中的经验，以评估与胸骨切开术相比，这种新方法的临床和肿瘤学结局。
对84例因不同胸腺疾病（尤其是胸腺瘤）接受胸腺切除术的患者进行回顾性分析。18例患者接受了无CO的VATS单孔胸腺切除术，而66例患者通过开放胸骨切开术进行了胸腺切除术。记录了许多与手术和临床结局相关的临床因素，包括肿瘤复发和临床缓解情况。
两组均未观察到严重的术后并发症。无CO的VATS单孔胸腺切除术的中位手术时间和术后住院时间分别为95分钟和1天，开放胸骨切开术则为120分钟和7天。胸腺瘤是最常见的胸腺疾病，VATS组有7例（38%），开放手术组有28例（42.4%）。VATS组的中位病变大小为2.6厘米，开放手术组为3.2厘米。在随访期间，VATS组患者未观察到胸腺瘤复发，而开放手术组观察到14.28%的复发，分布如下：局部复发占75%，远处复发占25%；这些患者的无病生存期为8.3个月。VATS组6例（33%）患者和胸骨切开术组32例（48%）患者的胸腺切除术与重症肌无力（MG）相关；我们关于胸腺切除术治疗MG的结果是根据MG干预后的状态[完全稳定缓解（CSR）、药物缓解、轻微表现、改善、不变、加重恶化以及死于MG]确定的，两种方法的结果相似。
无CO的VATS单孔胸腺切除术是一种可行且安全的手术。肿瘤学结局与开放手术方法相似。与胸骨切开术相比，并发症、手术时间和住院时间更短。这是初步经验，需要进一步研究以评估长期结果。
