G. Manyak, A. Bassiri, Christine E. Alvarado, Kunaal S Sarnaik, Jilian Sinopoli, Leonidas Tapias, P. Linden, C. Towe
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Patients undergoing MIS were older, had fewer comorbidities, and had smaller tumors (median; 4.6 vs 6 cm, P < .001). In the unmatched cohort, MIS and open had similar 90-day mortality (1.1% vs 1.8%, P = .158) and rate of positive margin (25.1% vs 27.9%, P = .109). MIS thymectomy was associated with shorter LOS (2 (1-4) vs 4 (3-6) days, P < .001). Propensity matching reduced the bias between the groups. In this cohort, overall survival was similar between the groups by log-rank test (P = .462) and multivariate cox hazard analysis (HR .882, P = .472). Multivariable regression showed shorter LOS with MIS approach (Coef -1.139, P < .001), and similar odds of positive margin (OR 1.130, P = .150).\n\n\nDISCUSSION\nMIS has equivalent oncologic benefit to open resection for large thymomas, but is associated with shorter LOS. When clinically appropriate, MIS thymectomy may be considered a safe alternative to open resection for large thymomas.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"47 19","pages":"31348241246180"},"PeriodicalIF":0.0000,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Is Minimally Invasive Resection of Large Thymoma Appropriate?\",\"authors\":\"G. Manyak, A. Bassiri, Christine E. Alvarado, Kunaal S Sarnaik, Jilian Sinopoli, Leonidas Tapias, P. Linden, C. Towe\",\"doi\":\"10.1177/00031348241246180\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"BACKGROUND\\nCurrent practice patterns suggest open rather than minimally invasive (MIS) approaches for thymomas >4 cm. 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引用次数: 0
摘要
背景目前的实践模式建议对大于4厘米的胸腺瘤采用开放式而非微创(MIS)方法。我们假设,在大胸腺瘤(>4 厘米)切除术中,开放式和 MIS 方法的围手术期结果和总生存率相似。方法:我们在国家癌症数据库中查询了 2010 年至 2020 年期间接受胸腺切除术的患者。手术方法分为开放式或 MIS。主要结果是总生存率,次要结果是边缘状态和住院时间(LOS)。结果在4121例胸腺切除术中,2474例(60%)为开腹手术,1647例(40%)为MIS手术。接受MIS手术的患者年龄较大,合并症较少,肿瘤较小(中位数:4.6 vs 6 cm,P < .001)。在非匹配队列中,MIS和开胸手术的90天死亡率(1.1% vs 1.8%,P = .158)和边缘阳性率(25.1% vs 27.9%,P = .109)相似。MIS胸腺切除术与较短的LOS相关(2 (1-4) 天 vs 4 (3-6) 天,P < .001)。倾向匹配减少了组间偏差。在该队列中,通过对数秩检验(P = .462)和多变量考克斯危险分析(HR .882,P = .472),两组的总生存率相似。多变量回归显示,MIS方法的LOS更短(Coef -1.139, P < .001),阳性边缘几率相似(OR 1.130, P = .150)。在临床上,MIS胸腺切除术可被视为大胸腺瘤开胸切除术的安全替代方案。
Is Minimally Invasive Resection of Large Thymoma Appropriate?
BACKGROUND
Current practice patterns suggest open rather than minimally invasive (MIS) approaches for thymomas >4 cm. We hypothesized there would be similar perioperative outcomes and overall survival between open and MIS approaches for large (>4 cm) thymoma resection.
METHODS
The National Cancer Database was queried for patients who underwent thymectomy from 2010 to 2020. Surgical approach was characterized as either open or MIS. The primary outcome was overall survival and secondary outcomes were margin status, and length of stay (LOS). Differences between approach cohorts were compared after a 1:1 propensity match.
RESULTS
Among 4121 thymectomies, 2474 (60%) were open and 1647 (40%) were MIS. Patients undergoing MIS were older, had fewer comorbidities, and had smaller tumors (median; 4.6 vs 6 cm, P < .001). In the unmatched cohort, MIS and open had similar 90-day mortality (1.1% vs 1.8%, P = .158) and rate of positive margin (25.1% vs 27.9%, P = .109). MIS thymectomy was associated with shorter LOS (2 (1-4) vs 4 (3-6) days, P < .001). Propensity matching reduced the bias between the groups. In this cohort, overall survival was similar between the groups by log-rank test (P = .462) and multivariate cox hazard analysis (HR .882, P = .472). Multivariable regression showed shorter LOS with MIS approach (Coef -1.139, P < .001), and similar odds of positive margin (OR 1.130, P = .150).
DISCUSSION
MIS has equivalent oncologic benefit to open resection for large thymomas, but is associated with shorter LOS. When clinically appropriate, MIS thymectomy may be considered a safe alternative to open resection for large thymomas.