Minimally Invasive Thymectomy and Open Thymectomy: Outcome Analysis of 263 Patients

Background. An open thymectomy is a morbid procedure. If a minimally invasive thymectomy is performed without compromising the tenets of thymic surgery, it has the potential for decreasing morbidity and may offer similar clinical and oncologic results. Methods. This is an institutional review board-approved, retrospective study of a single center's experience with both open (transsternal) and minimally invasive (video-assisted thoracoscopic surgery) thymectomy. Survival estimates and statistical comparisons were calculated using standard software. Results. From 2000 to 2011, 263 patients (93 men; median age, 49 years; interquartile range, 37 to 60 years) underwent thymectomy for indications including myasthenia gravis (n = 139) and mediastinal mass (n = 108). Seventy-seven thymectomies were performed by minimally invasive approach. Both groups were equally stratified by sex, body mass index, World Health Organization and Masaoka-Koga staging, incidence of myasthenia gravis, and comorbidities except hyperlipidemia and diabetes. The minimally invasive thymectomy cohort had significantly shorter hospital (p < 0.01) and intensive care unit lengths of stay (p < 0.01) and a lower estimated blood loss (p < 0.01). There was an insignificant difference in postoperative cardiac and respiratory complication rates as well as vocal cord paralysis (p = 0.60). There was no difference in terms of operative room times (p = 0.88) or volume of blood products transfused (p = 0.16) between the two groups. Higher estimated blood loss was associated with higher intensive care unit admission rates (p < 0.01). All minimally invasive thymoma resections were complete, with negative margins. Conclusions. Minimally invasive thymectomy is safe and achieves a comparable resection and postoperative complication profile when used selectively for all indications, including myasthenia gravis and small thymomas without vascular invasion.