Surgical approach for the treatment of thymic carcinoma: 201 cases from a multi-institutional study

Purpose: This study aimed to compare the outcomes of surgical approach (video-assisted thoracoscopic surgery [VATS] vs. sternotomy vs. thoracotomy) for the treatment of thymic carcinoma Methods: We retrospectively reviewed 201 patients with pathologically proven thymic carcinoma who underwent surgical resection at four Korean institutions. Results: From 2007 to 2013, 158 sternotomy, 33 VATS and 10 thoracotomy were conducted for thymic carcinoma. Open group underwent more preoperative biopsy (41.8% and 50% vs. 15.2%, P=0.012) and neoadjuvant treatment (22.2% and 30% vs. 0%, P=0.008) than VATS group. In preoperative imaging, tumor size of VATS group was smaller than sternotomy group (3.8±1.1 cm vs. 5.8±2 cm, P<0.05) and 91% of the VATS group was clinical tumor-node-metastasis (TNM) stage I. The lengths of chest tube and mechanical ventilation duration, postoperative hospital day and intensive care unit stay were shorter in VATS group than open group (P<0.001). The incidence of postoperative complications of VATS group was lower than sternotomy group (P=0.014). The 5-year overall survival of the sternotomy, VATS and thoracotomy group were 100%, 100% and 87.5%±11.7%, respectively (P=0.107). The 5-year recurrence-free survival rate was not significantly different between the groups (55.4%±4.5%, 67.9%±12.1%, and 87.5%±11.7%; P=0.131) Conclusion: The VATS approach of surgical treatment for thymic carcinoma can be selectively employed in small (<5 cm) and TNM stage I tumor without compromise of oncologic outcome.