Abstract
BACKGROUND: Thymectomy was the standard method for the treatment of thymoma. Video-assisted thoracoscopic (VATS) thymectomy was developed more than 20 years ago and has become a widely accepted surgical approach. We consistently performed 3-port VATS simple thymectomy for thymoma. Our indications for VATS simple thymectomy are thymoma without myasthenia gravis (MG) less than 10 cm in the maximum diameter and positioned below jugular notch of the sternum. Extended surgical procedures are thymectomy with combined resection of internal thoracic artery and vein, lung, pericardium, phrenic nerve and diaphragm. METHODS: We retrospective reviewed 502 patients who underwent surgery for mediastinal tumor or disease in our department between 2005 and 2014. Eighty-eight patients underwent VATS thymectomy for thymoma without MG (we performed VATS extended thymectomy for MG). All procedures were performed under general anesthesia with one-lung ventilation. Patients were placed in the lateral decubitus position and three ports were made. We performed VATS thymectomy using mainly right-sided approach because of easy understanding of the anatomy. Left-sided approach was chosen in cases of suspected invasion for left lung or thoracic organs. We hardly insert chest drain unless lung resection or injury. RESULTS: The 88 patients (40 men, 48 women) were mean age of 58±12 years. There were 62 right-sided approaches and 26 left-sided approaches. A total of 75 patients received a simple thymectomy, 5 with combined resection of lung, 4 were of pericardium (2 were of lung and pericardium), and 6 were of other lung diseases. The mean operation time was 140±48 min, mean intraoperative blood loss was 71 mL, and mean postoperative hospital stay was 3 days. There were no operative death or severe complications, and no conversions to open thoracotomy. The pathologic stage was classified as Masaoka stage I in 39, stage II in 46, stage III in 2 and stage IV in 1. It was also classified as WHO classification A in 12, AB in 30, B1 in 14, B2 in 28 and B3 in 4. The mean tumor diameter was 45.2±23 (range, 13–100) mm. Recurrence was observed in 2 cases (2.3%) as disseminations. One was 72 mm, stage II, type B1, the other was 50 mm, stage II, type B2. CONCLUSIONS: VATS thymectomy was safe procedure and can be a curative treatment choice.