| Objective Evaluating the impact of tumor size on the safety and feasibility of thoracoscopic thymectomy.Methods From January 2008 to December 2017,patients undergoing thoracoscopic thymectomy were prospectively collected.Patients who had stage M1 thymic tumors or received preoperative induction therapy were excluded from this study.Patients who underwent VATS exploration,converted to open surgery because of extensive tumor invasion,were also excluded.All cases were divided into group A(tumor size ≤5cm)and group B(tumor size >5cm)according to their longest dimension in transverse section on CT scan.Peri-operative outcomes and follow-up results of these groups were compared after propensity-score matching(PSM).Results A total of 235 cases were retrospectively reviewed in the study with 154 cases in group A and 81 cases in group B.To compare group A and B,PSM produced 131 cases for group A’ and 78 cases for group B’ by balancing age,myasthenia gravis,p T stage(T2 and T3 combined)and histological subtype.There was no statistical difference between the two groups in patient demographics or tumor characteristics.No difference was observed in the conversion incidence(1.5% vs 5.1%,P=0.280)and R0 resection rate(96.9% vs 94.9%,P=0.538).Co-resection of invaded structures,including but not limited to left innominate vein and wedge lung resection,was comparable between the two groups(24.4% vs 26.9%,P=0.688).Operative time was shorter in group A’ than in group B’(P=0.004).There was no difference in the amount of blood loss(P=0.141),duration of chest tube drainage(P=0.050),length of postoperative hospital stay(P=0.099),and incidence of postoperative complications(P=0.835)in the two groups.During follow-up,there were 6 cases of recurrence in group A’ but none in group B’.Conclusion In contrast with treating smaller thymic tumors,thoracoscopic thymectomy is also safe and effective for the surgical treatment of thymic tumors larger than 5cm.Objective To compare thoracoscopic thymectomy to open thymectomy in the safety and efficacy of treating thymic tumors larger than 5cm.Methods From January 2008 to December 2017,patients with thymic tumors larger than 5cm undergoing thoracoscopic or open thymectomy were prospectively collected.Patients who had stage M1 thymic tumors or received preoperative induction therapy were excluded from this study.Patients who underwent VATS exploration,converted to open surgery because of extensive tumor invasion,were also excluded.All cases were divided into group A(VATS)and group B(OT)according to their surgical approach.Peri-operative outcomes and follow-up results of these two groups were compared after propensity-score matching(PSM).Results A total of 122 cases were retrospectively reviewed in the study with 81 cases in group A and 41 cases in group B.To compare group A and B,PSM produced 38 cases for group A’ and 24 cases for group B’ by balancing age,gender,tumor size,p T stage(T2 and T3 combined)and histological subtype.There was no statistical difference between the two groups in patient demographics or tumor characteristics.R0 resection rate(94.7% vs 95.8%,P=1.000)and co-resection of invaded structures(36.8% vs 50%,P=0.306)were comparable between the two groups.There was no difference in operative time(P=0.710)and the incidence of postoperative complications(P=1.000)between the two groups.While group A’ had less amount of blood loss(P=0.000),shorter duration of chest tube drainage(P=0.036)and length of postoperative hospital stay(P=0.000).During follow-up,there were 2 cases of recurrence in group B’ but none in group A’.Conclusion Compared with open thymectomy,thoracoscopic thymectomy is safe and effective in the treatment of thymic tumors larger than 5cm with better perioperative outcomes and comparable oncological results.Objective To investigate the correlation between tumor size and T stage and the impact of tumor size on the prognosis of thymic tumors.Methods From January 2008 to December 2017,patients undergoing thoracoscopic or open thymectomy were prospectively collected.Patients who had stage M1 thymic tumor or preoperative induction therapy were excluded from the study.Kendall’s tau-b correlation analysis were used to explore the correlation between tumor size and T stage.Kaplan-Meier univariate analysis and Cox regression were applied to study the impact of tumor size on the prognosis of thymic tumors.Results A total of 303 patients were retrospectively reviewed in the study.There were 169(55.8%)males.The average age was 54 years old.The mean tumor size was 4.8 ±1.9 cm,with a median of 4.7(1.2,11.0)cm.In general,the correlation coefficient between tumor size and T stage was 0.141(P=0.002).Further study showed that there was no correlation between tumor size and T stage in type A/AB thymoma(P=0.384).The correlation coefficient between tumor size and T stage for type B thymoma and TC/NETT were 0.148(P=0.042)and 0.308(P=0.003)respectively.Univariate analysis showed that higher T stage(P=0.000),N stage(P=0.004),and worse histological subtype(P=0.005)were risk factors of recurrence after R0 resection.Multivariate analysis showed that higher T stage(P=0.006)and N stage(P=0.019)were independent risk factors of recurrence.In addition,multivariate analysis showed that independent risk factors associated with cause-specific survival(CSS)included N stage(P=0.002)and resection rate(P=0.000).Conclusion In stage M0 patients without induction therapy,there is a correlation between tumor size and T stage,but it is not an independent risk factor of recurrence. |
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