Abstract
BACKGROUND: Over the past decades, there has been a shift towards robotic resection for thymic tumors. The objective of our study was to characterize the transition to robotic-assisted thymectomy (RATS) in a historical cohort of patients undergoing thymectomy for thymic tumors. METHODS: We conducted a retrospective, single-center review of all robotic thymectomies for thymic epithelial tumors (TETs) between 2002 and 2022. Additionally, we analyzed data from patients who underwent resection of TETs using other approaches during the same period. RESULTS: During the study period, 348 patients were treated for TETs. The RATS group included 123 patients, 27% of whom were female, with a median [interquartile range (IQR)] age of 57 [48–66] years. Sixty-three (51%) patients had associated myasthenia gravis. In 16 (13%) cases, resection of structures other than the thymus was necessary. The conversion rate was 10%, with no intraoperative mortality. Pathological analysis revealed that most patients had a thymoma (97.6%), while there were only 2 cases of thymic carcinoma (1.6%) and 1 case of thymic carcinoid (0.8%). Tumor-node-metastasis (TNM) staging showed that the majority of patients had early-stage disease (stages I–II: 96%), with a median tumor size of 4.5 cm (range, 3–6 cm). The median duration of follow-up was 48 months (range, 24–72 months). There were 3 recurrences, and the 5-year disease-free survival (DFS) rate was 97%. While in the first half of our experience, RATS accounted for only 14% of thymectomies, in the latter half, this proportion increased to 45% (P<0.001), particularly for stage I–II cases (58%) (P<0.001). Additionally, we observed an increase in the dimension of lesions removed using the robotic approach (Figure 1), particularly the proportion of large tumors (≥5 cm) increased from 3% to 32% (P<0.001). CONCLUSIONS: Over the past 20 years, there has been a significant shift towards robotic thymectomy, particularly for early-stage disease. With increasing experience, more advanced-stage tumors and larger lesions are being considered for a robotic approach.