Objective To compare the clinical efficacy and safety of da Vinci robot with totally no tube (TNT) versus subxiphoid video-assisted thymectomy surgery (SVATS) in the treatment of thymic tumors. Methods From 2019 to 2021, a retrospective analysis was conducted on patients with thymic tumor resection in the Department of Thoracic Surgery, General Hospital of Northern Theater Command. All patients underwent total thymectomy and mediastinal fat removal, and they were divided into a TNT group and a SVATS group according to the operation method. The intraoperative blood loss, conversion rate, postoperative visual analogue score (VAS), postoperative hospital stay time and postoperative complications were compared between the two groups. Results We finally included 435 patiets. There were 168 patients with 83 males and 85 females at an average age of 61.920±9.210 years in the TNT group and 267 patients with 147 males and 120 females at an average age of 61.460±8.119 years in the SVATS group. There was no death or postoperative myasthenic crisis in both groups. There was no statistical difference in postoperative hospital stay (1.540±0.500 d vs. 3.400±0.561 d, P=0.000), intraoperative blood loss (13.450±5.498 mL vs. 108.610±54.462 mL, P=0.000), postoperative 24 h VAS score (4.960±1.757 points vs. 3.600±1.708 points, P=0.000), or postoperative complication rate (3.0% vs. 11.6%, P=0.001).Conclusion TNT is a more efficient, safe, and effective surgical approach for treating thymic tumors, which can shorten hospital stay time and reduce postoperative complications. However, SVATS can minimize postoperative pain.
Objective To compare the differences in clinicopathological features, molecular phenotypes, and prognosis between atypical type A thymoma (AAT) and classic type A thymoma (TAT), and to clarify the aggressive nature of AAT. Methods The data of AAT patients (AAT group) and classic TAT patients (TAT group) who underwent surgical resection for thymoma at West China Hospital of Sichuan University between January 2016 and November 2024 were retrospectively collected. Comparisons on the clinical data, histopathology, immunohistochemistry (CD20, Ki-67), GTF2I mutation status, and survival outcomes were performed between the two groups. Results A total of 53 patients were enrolled, including 22 in the AAT group and 31 in the TAT group. There was no significant difference in age, sex, or initial presenting symptoms between the two groups (P>0.05). Compared with the TAT group, the AAT group had larger tumors [(5.6±2.7) vs. (4.1±2.0) cm, P=0.043], a lower proportion of Masaoka stage Ⅰ (31.6% vs. 61.3%, P=0.041), and worse survival outcomes [progression-free survival: hazard ratio (HR)=2.87, 95% confidence interval (CI) (1.42, 5.81), P=0.004; overall survival: HR=1.96, 95%CI (1.02, 3.78), P=0.013]. Pathologically, the AAT group showed more mitotic figures (mean 6/2 mm2), and tumor necrosis was observed in 45.5% of cases. There was no statistically significant difference in the CD20 expression rate (20.0% vs. 41.9%), Ki-67 index [(11.0±6.0)% vs. (8.0±6.9)%], or GTF2I mutation rate (86.7% vs. 92.3%) between the two groups (P>0.05). Conclusions AAT is a subtype of TAT with distinct aggressive pathological features, including higher mitotic activity, a tendency for necrosis, and a greater propensity for recurrence and metastasis. Pathological diagnosis should integrate morphology and molecular testing to guide more aggressive treatment and follow-up strategies.
Thymic epithelial tumors represent the most common neoplasms of the anterior mediastinum, while atypical type A thymoma is a rare subtype of thymoma. On the morphological basis of type A thymoma, this tumor exhibits some atypical histological features, such as abundant cells, increased mitotic counts, tumor necrosis, and increased Ki67 index. At present, the clinical and pathological data of this tumor is still available. Since it was formally named, 16 cases have been reported around the world. In order to improve the understanding of the disease, this article reviews the related literature and tries to elaborate the atypical type A thymoma from the aspects of pathological features, clinical manifestations, epidemiology and differential diagnosis.
Objective To systematically review the effectiveness of thoracoscopy surgery and thoracotomy for thymoma. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2016), Web of Science, CBM, WanFang Data and CNKI were searched to collect randomized controlled trials (RCTs) and cohort studies about thoracoscopy surgery versus thoracotomy for thymoma from inception to April 2016. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Results A total of 5 RCTs and 8 cohort studies involving 1 093 patients were included. The results of meta-analysis showed that, compared with thoracotomy, the thoracoscopy surgery could shorten operative time (MD= –22.2, 95%CI –32.92 to –12.52, P < 0.000 01), duration of ICU stay (MD= –0.76, 95%CI –0.21 to –0.30, P < 0.000 01), duration of hospital stay (MD= –3.71, 95%CI –4.47 to –2.96, P < 0.000 01) and duration of pleural drainage (MD= –1.80, 95%CI –2.42 to –1.18, P < 0.000 01), reduce volume of intraoperative blood loss (MD= –43.27, 95%CI –50.94 to –35.60, P < 0.000 01), and decrease the incidence of postoperative complications (OR=0.19, 95%CI 0.11 to 0.34, P < 0.000 01), but there was no significant difference in recurrence rate between two groups (OR=0.81, 95%CI 0.31 to 2.11, P=0.67). Conclusions Current evidence shows that, compared with thoracotomy, the thoracoscopy surgery for thymoma has shorter operative time, duration of ICU stay, duration of hospital stay, and duration of pleural drainage, as well as less blood loss and postoperative complications. Due to the limited quality of included studies, more high-quality studies are needed to verify the above conclusion.
Anterior mediastinal inflammatory myofibroblastoma is a rare tumor with insidious onset and easy misdiagnosis. In this report, we presented a case of anterior mediastinal inflammatory myofibroblastoma with thymoma. The mediastinal tumor was found by physical examination, and the prognosis was good after surgical treatment. For this disease, operation is an effective method for definite diagnosis and treatment, and complete excision can achieve good outcomes.
Objective To compare and analyze the occurrence of acute and chronic pain after subxiphoid and transcostal thoracoscopic extended thymectomy. MethodsA retrospective analysis was performed on 150 patients who underwent thoracoscopic extended thymectomy in our hospital from July 2020 to June 2022, among whome 30 patients received subxiphoid video-assisted thoracic surgery, and 120 patients received transcostal video-assisted thoracic surgery. The patients were matched by the propensity score matching method. Postoperative pain was evaluated by numeric rating scale (NRS). The intraoperative conditions and postoperative pain incidence were compared between the two groups. ResultsAfter matching, 60 patients were enrolled, 30 in each group, including 30 males and 30 females with an average age of 50.78±12.13 years. There was no difference in the general clinical data between the two groups (P>0.05), and no perioperative death. There were statistical differences in the intraoperative blood loss, postoperative drainage volume, postoperative catheter duration, postoperative hospital stay, postoperative pain on 1 d, 2 d, 3 d, 7 d, 3 months and 6 months after the surgery (P<0.05), but there was no statistical difference in the operation time or the postoperative 14 d NRS score (P>0.05). Further univariate and multivariate analyses for postoperative chronic pain showed that surgical method and postoperative 14 d NRS score were risk factors for chronic pain at the 3 months and 6 months after the surgery (P<0.05). Conclusion The subxiphoid thoracoscopic extended thymectomy has advantages over transcostal thoracoscopic surgery in the postoperative acute and chronic pain.
ObjectiveTo compare clinical effects of enlarged thymectomy for the treatment of myasthenia gravis (MG) complicated with thymoma via subxiphoid and subcostal arch thoracoscopic resection versus median sternotomy resection. MethodsWe retrospectively analyzed the clinical data of patients with MG complicated with thymoma admitted in Tangdu Hospital of the Air Force Military Medical University between December 2011 and December 2021. Patients who underwent subxiphoid and subcostal arch thoracoscopic enlarged thymectomy were allocated to a SR group, and patients who underwent median sternotomy enlarged thymectomy were allocated to a MR group. Perioperative outcomes were compared between the two groups. ResultsA total of 456 patients were collected. There were 51 patients in the MR group, including 30 males and 21 females aged 23-66 (49.5±11.8) years. There were 405 patients in the SR group, among whom 51 patients were matched to the MR group by propensity score matching, including 28 males and 23 females aged 26-70 (47.2±12.2) years. The operations were accomplished successfully in all patients, and no conversion to thoracotomy occurred in the SR group. The SR group had advantages in the operation time, intraoperative blood loss, chest drainage duration, hospital stay time, patients’ satisfaction level, pain score and complications (all P<0.05). No statistical difference was found in the number of intraoperative lymph node dissection stations, number of intraoperative lymph nodes dissected or remission of MG between the two groups (P>0.05). ConclusionSubxiphoid and subcostal arch thoracoscopic enlarged thymectomy and lymphadenectomy is a safe, effective and feasible minimally invasive procedure for the treatment of MG complicated with thymoma.
Abstract: Objective To investigate the clinical characteristics of thymoma and thymoma with myasthenia gravis(MG). Methods From Oct.1979 to July 2004,185 patients with thymoma were surgically treated. Among these patients, comparative analysis was made between 94 cases of thymoma (thymoma group) and 91 cases of thymus tumor with MG(thymoma with MG group).155 patients underwent radical operation (83.8%),16 patients underwent palliative operation (8.6%),and 14 patients underwent exploratory operation (7.6%). Clinical characteristics was analyzed in two groups. The factors affecting prognosis was analyzed by Masaoka’s stage system, with the lifttable method. Results Five patients died after operation, others had complete remission or symptomatic improvement. There was statistically difference of Masaoka’s stage system in two groups (χ2=53.14, P＜0.05). There were no statistically difference in pathological type of thymoma and clinical type of MG and pathologic period (χ2=8.21, P＞0.05). 57 cases of thymoma group were followed up, the duration of follow-up was 1 to 10 years, average follow-up was 40.7 months, and the patients with 1-, 3- and 5-year survival rates were 70.2% (40/57), 66.7% (22/33), 593% (16/27) respectively. 55 cases of thymoma with MG group were followed up. The patients’ survival rates were 98.2% (54/55), 86.4% (38/44), 81.6% (31/38) at 1-, 3-and 5-year respectively. There was no statistically difference of survival rates in two groups (χ2=0.83, P＞0.05). Totally, 112 patients were followed up in two groups, by Masaoka’s stage system, the 5-year survival rates were 93.7% for stage Ⅰ, 79.2% for stageⅡ, 51.4% for stage Ⅲ and 0% for stage Ⅳ respectively. Result of asaoka’s stage system evidence was statistically significant (χ25-year=51.62, P＜0.01). Conclusions Pathological type of thymoma isn’t related to modified Osserman’s classification, prognosis of thymoma is obviously related to Masaoka’s stage and isn’t related to MG. Generalized MG is the major type in MG patients accompanied by thymomas, and the major pathological type is lymphocytic. Chest CT can increase the accuracy early diagnosis of thymoma. The principal treatment is to resect the tumor as completely as possible, and proper administration of postoperative radiotherapy or chemotherapy according to the surgical status. Operative program and tumor stage are the most important prognostic factors.
ObjectiveTo compare the efficacy and safety of video-assisted thoracoscopic surgery (VATS) thymectomy for the treatment of thymoma through subxiphoid uniportal approach using double sternum retractors, and subxiphoid and subcostal arch approach. Methods We retrospectively analyzed the clinical data of the patients diagnosed with thymoma who underwent VATS thymectomy from June 2023 to June 2024 in West China Hospital. Patients were categorized based on the surgical approach into two groups: a subxiphoid uniportal VATS thymectomy (SUVT) group and a subxiphoid and subcostal arch VATS thymectomy (SASAT) group. Comparisons were made between the two groups regarding surgical duration, intraoperative blood loss, postoperative drainage, thymoma size and location, and postoperative pain assessed using the visual analogue scale (VAS). ResultsThe SUVT group consisted of 20 patients, including 11 males and 9 females, with an average age of (51.5±14.3) years. The SASAT group comprised 40 patients, including 26 males and 14 females, with an average age of (50.0±13.0) years. Compared to the SASAT group, the SUVT group had significantly larger thymomas [ (5.9±2.7) cm vs. (4.2±2.1) cm, P=0.010] and a higher proportion of neoplasms located in the superior mediastinum (30.0% vs. 2.5%, P=0.007). Additionally, the VAS pain scores on postoperative days 3, 7, and 30 were significantly lower in the SUVT group compared to the SASAT group (P<0.05). There were no statistical differences between the two groups in demographic characteristics, operative time, intraoperative blood loss, duration and volume of postoperative drainage, length of postoperative hospital stay, or the VAS pain score on the first postoperative day. Conclusion SUVT using double sternum retractors significantly reduces postoperative pain and provides superior efficacy in the resection of larger thymomas or those situated in the superior mediastinum.