The oncological feasibility and limitations of video-assisted thoracoscopic thymectomy for early-stage thymomas

Although video-assisted thoracoscopic thymectomy (VATS-Tx) for thymoma has been introduced, its oncological outcome remains unclear. Our institutional experience with early-stage thymoma was retrospectively reviewed to evaluate the oncological feasibility of thoracoscopic thymectomy. A retrospective review consisting of 74 patients with Masaoka Stage I and II thymomas who had undergone thymectomy was performed. Forty-five patients underwent thoracoscopic thymectomy, while 29 underwent thymectomy through the open sternotomy approach. The clinical factors associated with the surgical outcome, including tumour recurrence, were investigated. Neither operative death nor major postoperative complications were observed. The median intraoperative blood loss and operative time of thoracoscopic thymectomy were 50 ml and 180 min, respectively. Among the patients with thymomas > 5 cm, the number of patients with operative time > 4 h was 9 of 26 (34.6%) in the thoracoscopic thymectomy and 1 of 21 (4.8%) in the open sternotomy groups. Pleural recurrence was observed in 3 (6.7%) patients with thymoma > 5 cm only in the thoracoscopic thymectomy group. Tumour capsule injury by manipulation during the operation was recorded in 2 of these 3 patients. In 2 of the 3 cases who had tumours with cystic portions on computed tomography, a tumour capsule injury occurred due to manipulation during thoracoscopic thymectomy. VATS-Tx for early-stage thymomas is feasible, while the indications should be carefully considered in patients with large or cystic tumours. The conventional open sternotomy approach could be recommended in patients with thymomas > 5 cm to avoid capsule injury.