Weng Wenhan, Li Xiao, Meng Shushi, Liu Xianping, Peng Peng, Wang Zhenfan, Li Jianfeng, Wang Jun
Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.
Peking University Health Science Center, Beijing, China.
Interact Cardiovasc Thorac Surg. 2020 Apr 1;30(4):565-572. doi: 10.1093/icvts/ivz320.
Video-assisted thoracoscopic thymectomy is becoming the preferable approach for early-stage thymoma. However, large thymomas are still recognized as a relative contraindication due to the possible risk of incomplete resection or capsular disruption. Thus, the aim of this study is to evaluate the feasibility of video-assisted thoracoscopic thymectomy for large thymomas.
Patients diagnosed with Masaoka stage I-IV thymoma between April 2001 and December 2018 were retrospectively reviewed. All patients were divided into 2 groups: thymoma <5.0 cm (group A) and thymoma ≥5.0 cm (group B). Propensity score matching analysis was performed to compare postoperative results. Recurrence-free survival and overall survival were compared for oncological evaluation.
A total of 346 patients were included in this study. In the propensity score matching analysis, 126 patients were included both in group A and group B. There was no significant difference between these 2 groups in terms of the R0 resection rate (95.2% vs 94.4%, P = 1.000), conversion rate (1.6% vs 3.2%, P = 0.684), operation time (119.4 ± 48.4 vs 139.1 ± 46.6 min, P = 0.955), blood loss (93.2 ± 231.7 vs 100.5 ± 149.3 ml, P = 0.649), duration of chest drainage (2.7 ± 1.6 vs 2.8 ± 2.0 days, P = 0.184), length of hospitalization (5.0 ± 3.9 vs 5.2 ± 2.9 days, P = 0.628) or postoperative complications (5.9% vs 8.5%, P = 0.068). There was no significant difference between these 2 groups in terms of the overall survival (P = 0.271) and recurrence-free survival (P = 0.288).
Video-assisted thoracoscopic thymectomy is a safe and effective approach for large thymomas (≥5 cm) with comparable surgical and oncological results.
电视辅助胸腔镜下胸腺切除术正成为早期胸腺瘤的首选治疗方法。然而，由于存在切除不完全或包膜破裂的潜在风险，大型胸腺瘤仍被视为相对禁忌证。因此，本研究旨在评估电视辅助胸腔镜下胸腺切除术治疗大型胸腺瘤的可行性。
回顾性分析2001年4月至2018年12月期间诊断为Masaoka I-IV期胸腺瘤的患者。所有患者分为两组：胸腺瘤＜5.0 cm（A组）和胸腺瘤≥5.0 cm（B组）。采用倾向评分匹配分析比较术后结果。比较无复发生存率和总生存率进行肿瘤学评估。
本研究共纳入346例患者。在倾向评分匹配分析中，A组和B组各纳入126例患者。两组在R0切除率（95.2%对94.4%，P = 1.000）、中转率（1.6%对3.2%，P = 0.684）、手术时间（119.4±48.4对139.1±46.6分钟，P = 0.955）、失血量（93.2±231.7对100.5±149.3毫升，P = 0.649）、胸腔引流时间（2.7±1.6对2.8±2.0天，P = 0.184）、住院时间（5.0±3.9对5.2±2.9天，P = 0.628）或术后并发症（5.9%对8.5%，P = 0.068）方面均无显著差异。两组在总生存率（P = 0.271）和无复发生存率（P = 0.288）方面也无显著差异。
电视辅助胸腔镜下胸腺切除术是治疗大型胸腺瘤（≥5 cm）的一种安全有效的方法，手术和肿瘤学结果相当。
