Abstract
BACKGROUND: The best minimally invasive approach for anterior mediastinal tumors in geriatric patients is unknown. The objective of this study was to evaluate clinical outcomes of video-assisted thoracic surgery (VATS) using subxiphoid (S-VATS) and lateral intercostal (I-VATS) approaches with specific emphasis on perioperative safety and early postoperative recovery in geriatric patients. METHODS: A total of 293 VATS resections of anteromedial mediastinal tumors were performed from June 2017 to June 2022; of these, 48 patients were classified as elderly (≥ 65 years). A propensity score matching analysis was performed to balance baseline covariates to compare outcomes between S-VATS (n = 15) and I-VATS (n = 33) patients, as well as additional comparisons to younger cohorts. RESULTS: Elderly patients had significantly more comorbidities than younger patients (58.3% vs 32.7%, p = 0.001). The S-VATS approach in elderly patients resulted in decreased early postoperative pain as compared to the I-VATS approach (24-h VAS-2.53 ± 0.63 vs 3.63 ± 1.04, p = 0.017). Operative time, intraoperative blood loss, and postoperative complication rate were similar across both groups, suggesting that both approaches were equally safe. CONCLUSION: Both S-VATS and I-VATS for anterior mediastinal tumor resection are safe and feasible in geriatric patients. The S-VATS approach may have the advantage of better early postoperative pain control, although this must be interpreted with caution due to the small sample size and evaluation of pain at a single postoperative point. Further studies are warranted to validate these findings, including larger prospective studies.