Johnathan Tavares, Timothy Newhook, Christopher Greenleaf, Benny Weksler. University of Pittsburgh Medical Center and Thomas Jefferson Univesrity Hospital
Purpose – This study was conducted to compare perioperative outcomes in patients undergoing robotic-assisted (RA) or traditional transsternal (TS) thymecotmy. Complete thymectomy is the procedure of choice in the treatment of thymomas and in the treatment of selected patients with myasthenia gravis (MG). Transsternal thymectomy is considered the gold standard for the treatment of MG and thymomas. Robotic-assisted thymectomy has emerged as an alternative to open transsternal surgery and has become the procedure of choice for patients with thymoma or MG in our practice.
Methods – We performed a retrospective chart review of all patients who underwent RA or TS thymectomy at our institution from February 2001 to February 2010. Data is presented as mean±SD. Student’s t-test and Pearson chi square analyses were performed. Significance was set as p<0.05.
Results – Fifty consecutive patients underwent either TS (35) or RA (15) thymectomy. Patient demographics were similar between groups. The incidence of MG was 5/15 in the TA group and 6/35 in the TS group (p=0.269). There were 10/15 patients with thymoma in the RA group and 14/35 in the TS group. Tumor size was 4.78±1.90 cm in the RA group and 4.41±1.08 in the TS group (p=0.569). There were no conversions to open surgery in the RA group and all procedures were completed robotically. Estimated blood loss was significantly higher in the TS group (151 ml vs. 41 ml, p=0.01). There were 11 postoperative complications in the TS group and 1 complication in the RA group (p=0.022). There was 1 mortality in the TS group and none in the RA group (p = 1.0). Hospital length of stay was 5.6±4 days in the TS group and 1.8±1.6 days in the RA group (p=0.002).
Conclusions – Robotic-assisted thymectomy is superior to transsternal thymectomy, reducing intraoperative blood loss, postoperative complications, and hospital length of stay. Further investigation of the long-term oncologic results in thymoma patients and long-term remission rates in patients with MG undergoing RA thymectomy are needed.
Program Number: S101