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Yang X, Jiang J, Ao Y, Zheng Y, Gao J, Wang H, Liang F, Wang Q, Tan L, Wang S, Ding J. Perioperative outcomes and survival of modified subxiphoid video-assisted thoracoscopic surgery thymectomy for T 2-3 thymic malignancies: A retrospective comparison study. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00367-2. [PMID: 38692477 DOI: 10.1016/j.jtcvs.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/01/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Our previous study demonstrated that modified subxiphoid video-assisted thoracic surgery thymectomy with an auxiliary sternal retractor is feasible for locally invasive thymic malignancies. This study aimed to compare perioperative and oncological outcomes of modified subxiphoid video-assisted thoracoscopic surgery thymectomy versus median sternotomy thymectomy for locally advanced thymic malignancies. METHODS In total, 221 patients with T2-3 thymic malignancies who underwent modified subxiphoid video-assisted thoracoscopic surgery thymectomy or median sternotomy thymectomy between 2015 and 2020 were enrolled in our prospectively maintained database. A 1:1 propensity score-matching analysis was performed to balance the bias. Surgical difficulty was evaluated with a modified resection index. Perioperative and oncological results were compared between the modified subxiphoid video-assisted thoracoscopic surgery thymectomy group and the median sternotomy thymectomy group. RESULTS There were 72 patients in each group in the final analysis. Our results showed that the modified subxiphoid video-assisted thoracoscopic surgery thymectomy group had a shorter operative duration (98 vs 129 minutes, P < .001), less blood loss (40 vs 100 mL, P < .001), shorter drainage duration (3 vs 5 days, P < .001), shorter length of hospital stay (5 vs 6 days, P < .001), and fewer postoperative complications (5.6% vs 23.6%; P = .005). No significant difference was detected in complete resection (98.6% vs 98.6%, P = 1.000) between the 2 groups. Conversion occurred in 5 of 106 patients (4.7%). Survival analyses indicated similar recurrence-free survival (hazard ratio, 0.94; 95% CI, 0.40-2.20; P = .883) and overall survival (hazard ratio, 0.52; 95% CI, 0.05-5.02; P = .590) between the 2 groups. CONCLUSIONS Modified subxiphoid video-assisted thoracoscopic surgery thymectomy was safe and effective for T2-3 thymic malignancies and could be an alternative for selected patients with locally advanced thymic diseases. Further prospective studies are needed to evaluate the long-term survival of those undergoing modified subxiphoid approach thoracoscopic thymectomy.
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Affiliation(s)
- Xinyu Yang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiahao Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yongqiang Ao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuansheng Zheng
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Gao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fei Liang
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuai Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Jianyong Ding
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
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Chen H, Xu B, Zhang Q, Chen P, Cai M, Yao J. Anterior mediastinal tumor surgery applying single-port thoracoscopy using the subxiphoid approach. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:239-248. [PMID: 37484634 PMCID: PMC10357856 DOI: 10.5606/tgkdc.dergisi.2023.23455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/29/2022] [Indexed: 07/25/2023]
Abstract
Background This study aims to investigate the effectiveness of application of single-port thoracoscopy using the subxiphoid approach in anterior mediastinal tumor surgery. Methods Between June 2014 and June 2016, a total of 108 patients (59 males, 49 females; mean age: 64.9±7.5 years; range, 45 to 79 years) with anterior mediastinal tumors were randomized into subxiphoid (experimental) or right chest (control) groups. Single-port thoracoscopy using the subxiphoid approach was performed in the subxiphoid group, while thoracoscopy using the right thoracic approach was performed in the control group. Preand postoperative pain stress indicators, Visual Analog Scale scores, quality of life scores, postoperative tumor recurrence, and five-year survival rates were compared between the groups. Results There were no mortality or serious complications in either group. The mean Visual Analog Scale pain scores on postoperative Days 1 and 7 were 6.5±0.8 and 2.9±0.8 in the subxiphoid group, respectively, compared to 7.2±0.8 and 3.4±0.8 in the control group (p<0.05 for all), respectively. The mean quality of life scores on postoperative Days 1 and 7 were 81.5±5.0 and 79.3±7.7, respectively, in the subxiphoid group compared to 72.4±4.3 and 71.3±4.8 in the control group, respectively (p<0.05 for all). Postoperative pain and pain mediator indexes were lower in the subxiphoid group (p<0.05 for all). The postoperative tumor recurrence rates were 3.70% and 20.37% in the subxiphoid and control groups, respectively (p=0.008). The five-year survival rates were 85.2% and 63.0% in the subxiphoid and control groups, respectively (p=0.008). Conclusion Single-port thoracoscopy using the subxiphoid approach is technically feasible, safe, and effective in performing surgery for anterior mediastinal tumors with an intact capsule and a tumor diameter of ≤5 cm.
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Affiliation(s)
- Hao Chen
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Hospital of Putian University, Putian, China
| | - Bindong Xu
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Hospital of Putian University, Putian, China
| | - Qiang Zhang
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Hospital of Putian University, Putian, China
| | - Pengfei Chen
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Hospital of Putian University, Putian, China
| | - Maoen Cai
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Hospital of Putian University, Putian, China
| | - Jinmei Yao
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Hospital of Putian University, Putian, China
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Zhang H, Wang F, Qiu G, Li Z, Peng L, Wang X, Xie S, Chen LQ, Wang Y. Safety and feasibility of a modularized procedure for trans-subxiphoid robotic extended thymectomy. Surg Endosc 2023; 37:90-100. [PMID: 35836034 DOI: 10.1007/s00464-022-09423-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/24/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The purpose of this study was to introduce an "eight-step modularized procedure (M-RET)" for trans-subxiphoid robotic extended thymectomy for patients with myasthenia gravis (MG). Its safety and feasibility were further verified in this study. MATERIALS AND METHODS This retrospective study included 87 consecutive MG patients who underwent trans-subxiphoid robotic extended thymectomy at our institution between September 2016 and August 2021. According to different resection models, patients were divided into two groups: traditional trans-subxiphoid robotic extended thymectomy group (T-RET group) and eight-step modularized technique group (M-RET group). Baseline demographic characteristics and operation-related parameters were collected and compared between the two groups. RESULTS There were 41 (47.1%) patients in the M-RET group and 46 (52.9%) patients in the T-RET group. The M-RET group resected a greater amount of mediastinal adipose tissues and required more dissection time (median and interquartile range: 135.0, 125.0 to 164.0 v. 120.0, 105.0 to 153.8, P = 0.006) compared with the T-RET group. There were no statistically significant differences in terms of the intraoperative blood loss, duration of chest drainage, length of hospital stay, and postoperative complications between the two groups. There was no mortality or conversion in each of the two groups and all patients recovered well upon discharge. CONCLUSION The eight-step modularized technique of trans-subxiphoid robotic extended thymectomy was verified to be a safe, effective, radical procedure, which offers unique superiority over ectopic thymic tissue resection.
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Affiliation(s)
- Hanlu Zhang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Fuqiang Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Guanghao Qiu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Zhiyang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Lei Peng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Xuyang Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Shenglong Xie
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.,Department of Thoracic Surgery, Hospital of the University of Electronic Science and Technology of China and Sichuan Provincial People's Hospital, Chengdu, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Yun Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.
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Rao M, Salami A, Robbins A, Schoephoerster J, Bhargava A, Diaz-Gutierrez I, Wang Q, Andrade R. Subxiphoid-subcostal versus transthoracic thoracoscopic thymectomy: A safe and feasible approach. JTCVS Tech 2022; 16:172-181. [PMID: 36510515 PMCID: PMC9735327 DOI: 10.1016/j.xjtc.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/21/2022] [Accepted: 08/05/2022] [Indexed: 12/16/2022] Open
Abstract
Objective Subxiphoid-subcostal thoracoscopic thymectomy (ST) is an emerging alternative to transthoracic thoracoscopic thymectomy. Potential advantages of ST are the avoidance of intercostal incisions and visualization of both phrenic nerves in their entirety. We describe our experience with ST and compare our results to our previous experience with transthoracic thoracoscopic thymectomy. Methods We conducted an institutional review board-exempt retrospective review of all patients who had a minimally invasive thymectomy from August 2008 to October 2021. We excluded patients with a previous sternotomy or radiological evidence of invasion into major vasculature. The ST approach involved 1 subxiphoid port for initial access, 2 subcostal ports on each side, and carbon dioxide insufflation. We used descriptive and comparative statistics on demographic, operative, and postoperative data. Results We performed ST in 40 patients and transthoracic thoracoscopic thymectomy in 16 patients. The median age was higher in the ST group (58 years vs 34 years; P = .02). Operative data showed no significant differences in operative times, blood loss, or tumor characteristics. In the ST group, we had 2 emergency conversions for bleeding; 1 ministernotomy, and 1 sternotomy. Postoperative data showed that the ST group had fewer days with a chest tube (1 day vs 2.5 days; P = .02). There were no differences in median length of stay, tumor characteristics, final margins, major complication rate, and opioid requirements between the groups. There has been no incidence of diaphragmatic hernia and no phrenic nerve injuries or mortality in either group. Conclusions ST is safe and has similar outcomes compared with transthoracic thoracoscopic thymectomy.
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Affiliation(s)
- Madhuri Rao
- Division of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn,Address for reprints: Madhuri Rao, MD, Division of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, MMC 207, 420 Delaware St, SE, Minneapolis, MN 55455.
| | - Aitua Salami
- Division of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn
| | - Alexandria Robbins
- Division of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn
| | - Jamee Schoephoerster
- Division of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn
| | - Amit Bhargava
- Division of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn
| | - Ilitch Diaz-Gutierrez
- Division of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn
| | - Qi Wang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minn
| | - Rafael Andrade
- Division of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn
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Liu YW, Chou SH, Chou A, Kao CN. Simultaneous Comparison of Subxiphoid and Intercostal Wound Pain in the Same Patients Following Thoracoscopic Surgery. J Clin Med 2022; 11:jcm11082254. [PMID: 35456345 PMCID: PMC9030809 DOI: 10.3390/jcm11082254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/10/2022] [Accepted: 04/15/2022] [Indexed: 12/10/2022] Open
Abstract
There is a lack of data comparing postoperative pain after subxiphoid and intercostal video-assisted thoracoscopic surgery (VATS). Pain is an individual’s subjective experience and, therefore, difficult to compare between different individuals subjected to either procedure. This study assessed reported pain at six postoperative time points in the same patients receiving both subxiphoid and intercostal incisions for thoracic disease. Data from 44 patients who received simultaneous combined intercostal and subxiphoid VATS were retrospectively analyzed from August 2019 to July 2021. All patients received the same length of subxiphoid and intercostal incisions with or without drain placements. A numerical pain rating scale was administered on postoperative days (POD)-1, POD-2, POD-Discharge, POD-30, POD-90, and POD-180. Bilateral uniportal VATS was performed in 11 patients, and unilateral multiportal VATS was performed in 33 patients. In the unilateral VATS group, there were no differences in pain reported for both incisions in the early postoperative period. However, in the bilateral VATS group, subxiphoid wounds resulted in significantly higher pain scores on POD-1, POD-2, and POD-Discharge (p = 0.0003, 0.001, and 0.03, respectively). Higher late (3 and 6 months) postoperative pain was associated with intercostal incisions in both groups, as previously reported, whereas higher early (day 1, 2, and discharge) postoperative pain was more associated with subxiphoid incisions than intercostal incisions in the bilateral VATS group.
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Affiliation(s)
- Yu-Wei Liu
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.C.); (C.-N.K.)
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University, National Health Research Institutes, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-3121101 (ext. 6305); Fax: +886-7-3127056
| | - Shah-Hwa Chou
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.C.); (C.-N.K.)
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Andre Chou
- Faculty of Medicine, Poznań University of Medical Sciences, 61-701 Poznań, Poland;
| | - Chieh-Ni Kao
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.C.); (C.-N.K.)
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Kang DK, Kang MK, Heo W, Hwang YH. Subxiphoid single-port thymectomy: six-year experience of a single center. ANZ J Surg 2021; 91:2188-2191. [PMID: 34405499 DOI: 10.1111/ans.17139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 07/05/2021] [Accepted: 08/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The subxiphoid single-port approach for thymectomy has several advantages compared with conventional lateral transthoracic approaches. However, perioperative outcomes of subxiphoid single-port thymectomy are still lacking. The objective of this study is to present our 6-year experience of subxiphoid single-port thymectomy, including our learning curve. METHODS All consecutive 49 patients undergoing subxiphoid single-port thymectomy between August 2014 and September 2020 were reviewed retrospectively. RESULTS We analyzed data of 49 patients (27 males and 22 females) with a median age of 58 years (range 49-68). Two patients presented postoperative complications. The conversion to a different approach was required in four cases. The median follow-up time was 17 months (range 3-35) and locoregional recurrence was observed in one patient. There were no intraoperative deaths and postoperative mortality. The operation time cumulative summation learning curve analysis revealed that the curves descended from the 24th case. CONCLUSIONS The subxiphoid single-port approach for thymectomy is a safe and feasible modality with few complications.
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Affiliation(s)
- Do Kyun Kang
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Min Kyun Kang
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Woon Heo
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Youn-Ho Hwang
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
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