Ann Thorac Surg 2020 Sep 11. Epub 2020 Sep 11.
Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY.
Background: There are limited reports on robotic thymectomy for malignant disease. Our objectives are to review our experience and mid-term outcomes.
Methods: We reviewed a single surgeon prospective database for patients who underwent planned robotic resection for malignancy from January 2010 to June 2019.
Results: A total of 213 patients underwent resection of an anterior mediastinal mass, all of which were planned for a robotic approach. Of these, 84 (39%) underwent robotic thymectomy for malignant disease. Thymoma was the most common pathology resected (68%). Median tumor size was 4.7 cm (interquartile range 2.9-6.3) and median operative time was 81.5 minutes (interquartile range 64-104). All except one patient had a complete (R0) resection (98.8%). There were two (2.3%) unplanned, but elective conversions to open surgery, one of which required cardiopulmonary bypass. Median length of stay was one day (0-9) with one readmission (1.2%). Major morbidity occurred in 3 patients (3.5%) and there were no 30- or 90-day mortalities. In patients with thymoma, follow-up was complete at a median of 32 months (range 1-98) and one patient (1.8%) had an ipsilateral chest recurrence. To date, there have been no patient deaths.
Conclusions: Robotic thymectomy for patients with malignant disease is safe with excellent perioperative outcomes. A robotic approach achieves a high rate of complete R0 resection, even for larger tumors. For patients with thymoma, local recurrence is low after mid-term follow-up, but longer-term analysis is needed to determine oncologic durability.