Video-assisted thoracoscopic thymectomy is feasible for large thymomas: a propensity-matched comparison

OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: Video-assisted thoracoscopic thymectomy is a safe and effective approach for large thymomas (>= 5 cm) with comparable surgical and oncological results.