Comparative analysis of the immediate results of thoracoscopic thymectomy using single-port and three-port approaches in the treatment of non-invasive epithelial thymic tumors

Purpose of the study. Evaluation of the safety and effectiveness of single-port thoracoscopic thymectomy in comparison with traditional three-port thymectomy in patients with stage I and II thymic epithelial tumors.

Patients and methods. The results of 50 thoracoscopic thymectomies performed from January 2019 to May 2023 on patients with stage I and II thymic epithelial tumors without the presence of myasthenia were analyzed. The age of the patients ranged from 20 to 75 years, with a median of 44 years. There were 28 (56 %) women, 22 (44 %) men. The minimum size of the removed thymoma in the study was 20 mm, the maximum was 165 mm. Out of the 50 patients who underwent singleand three-port thoracoscopic thymectomy, 42 (84 %) had tumor diameters of 70 mm or less, and 8 (16 %) had tumor diameters greater than 70 mm. Tumor size was significantly larger in the three-port thymectomy group (43 mm [35 mm; 55 mm] vs. 60 mm [38 mm; 78 mm], p = 0.044).

Results. The analysis noted a statistically significant increase in the duration of the operation in the group of three-port thoracoscopic thymectomies (duration of operations – 107.5 minutes [70 minutes; 132.5 minutes] versus 70.0 minutes [57 minutes; 79 minutes] in the group with a single-port approach). A statically significant result was also obtained in terms of drainage of pleural cavity drainage and, as a consequence, in duration of postoperative bed rest. Patients operated through a single-port approach stayed in the hospital for 3 to 5 days on average (4.0 days), while those with a three-port approach stayed from 3 to 13 days on average (5.0 days). A comparative analysis revealed a significant reduction in the length of hospital stay in patients who underwent single-port thoracoscopic thymectomy, in contrast to those undergoing three-port surgical interventions.

Conclusion. This study is the first in Russia to compare oneand three-port techniques for removing thymic tumors in a number of patients sufficient for statistical calculations. It has been shown that for thymic tumors up to 5 cm, single-port thoracoscopic thymectomy compared to three-port does not lead to prolongation of the operation or an increase in intraand postoperative complications. Therefore, in our opinion, it is the preferable option.

1. Miyata R, Hamaji M, Omasa M, Nakagawa T, Sumitomo R, Huang CL, et al. Survival outcomes after minimally invasive thymectomy for early-stage thymic carcinoma. Surg Today. 2019 Apr;49(4):357–360. https://doi.org/10.1007/s00595-018-1740-x

2. Friedant AJ, Handorf EA, Su S, Scott WJ. Minimally Invasive versus Open Thymectomy for Thymic Malignancies: Systematic Review and Meta-Analysis. J Thorac Oncol. 2016 Jan;11(1):30–38. https://doi.org/10.1016/j.jtho.2015.08.004

3. Ruffini E, Filosso PL, Guerrera F, Lausi P, Lyberis P, Oliaro A. Optimal surgical approach to thymic malignancies: New trends challenging old dogmas. Lung Cancer. 2018 Apr;118:161–170. https://doi.org/10.1016/j.lungcan.2018.01.025

4. Gung Y, Zhang H, Li S, Wang Y. Sternotomy versus video-assisted thoracoscopic surgery for thymectomy of myasthenia gravis patients: A meta-analysis. Asian J Endosc Surg. 2016 Nov;9(4):285–294. https://doi.org/10.1111/ases.12300

5. Lee Y, Samarasinghe Y, Patel J, Khondker A, McKechnie T, Samarasinghe N, et al. The short and long-term effects of open vs minimally invasive thymectomy in myasthenia gravis patients: a systematic review and meta-analysis. Surg Endosc. 2023 May;37(5):3321–3339. https://doi.org/10.1007/s00464-022-09757-y

6. Burt BM, Yao X, Shrager J, Antonicelli A, Padda S, Reiss J, et al. Determinants of Complete Resection of Thymoma by Minimally Invasive and Open Thymectomy: Analysis of an International Registry. J Thorac Oncol. 2017 Jan;12(1):129–136. https://doi.org/10.1016/j.jtho.2016.08.131

7. Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg. 2004 Feb;77(2):726–728. https://doi.org/10.1016/s0003-4975(03)01219-0

8. Wu CY, Heish MJ, Wu CF. Single port VATS mediastinal tumor resection: Taiwan experience. Ann Cardiothorac Surg. 2016 Mar;5(2):107–111. https://doi.org/10.21037/acs.2016.03.10

9. Yang CJ, Hurd J, Shah SA, Liou D, Wang H, Backhus LM, et al. A national analysis of open versus minimally invasive thymectomy for stage I to III thymoma. J Thorac Cardiovasc Surg. 2020 Aug;160(2):555–567.e15. https://doi.org/10.1016/j.jtcvs.2019.11.114

10. Minervini F, Boschetti L, Gregor M, Provencio M, Calvo V, Kestenholz PB, Lampridis S, Patrini D, Bertoglio P, Azenha LF, Sergi CM, Kocher GJ. Thymic tumours: a single center surgical experience and literature review on the current diagnosis and management of thymic malignancies. Gland Surg. 2021 Nov;10(11):3128–3140. https://doi.org/10.21037/gs-21-517

11. Li Q, Sihoe A, Wang H, Gonzalez-Rivas D, Zhu Y, Xie D, Jiang G. Short-term outcomes of singleversus multi-port video-assisted thoracic surgery in mediastinal diseases. Eur J Cardiothorac Surg. 2018 Jan 1;53(1):216–220. https://doi.org/10.1093/ejcts/ezx217

12. Pupovac SS, Newman J, Lee PC, Alexis M, Jurado J, Hyman K, et al. Intermediate oncologic outcomes after uniportal video-assisted thoracoscopic thymectomy for early-stage thymoma. J Thorac Dis. 2020 Aug;12(8):4025–4032. https://doi.org/10.21037/jtd-20-1370

13. Kovalenko VV, Dmitrochenko IV. The comparative analysis of using videothoracoscopic and open operations for the treatment of patients with tumors of thymus. Russian Military Medical Academy Reports. 2019;38(S1-1):208–210. (In Russ.). EDN ADAJDE

14. Dzidzava II, Dmitrochenko IV, Fufaev EE, Kotiv BN, Barinov OV, Yasyuchenya DA, Popov VA. Videothoracoscopic interventions for thymic neoplasms. Military Medical Journal 2020;341(5):52–56. (In Russ.). EDN TBSGIW

15. Efteev LA, Rodionov EO, Miller SV, Tuzikov SA, Velichko SA, Frolov IG, et al. Thoracoscopy in combined treatment of thymoma. Pirogov Russian Journal of Surgery. 2019;3(1):84–87. (In Russ.). https://doi.org/10.17116/hirurgia201903184

16. Kurganov IA, Panchenkov DN, Bogdanov DIu, Emel’ianov SI, Ivanov IuV, Khabarov YuA, Urazovskyi NYu. Comparative analysis of thymectomies through videothoracoscopic and transsternal approaches. Endoscopic Surgery. 2018;24(2):21–29. (In Russ.). https://doi.org/10.17116/endoskop201824221

17. Podobed AV, Kurchin VP, Bambiza AV, Savchenko OG, Malkevich VT. Comparative analysis of thoracoscopic and open thymectomy for thymoma stage I–II. Pirogov Russian Journal of Surgery. 2021;7:31–35. (In Russ.). https://doi.org/10.17116/hirurgia202105131

18. Allakhverdiev AK, Davydov MM, Ketsba AS. Thoracoscopic thymectomy — procedure of choice for noninvasive thymoma. Endoscopic Surgery. 2017;23(6):3–8. (In Russ.). https://doi.org/10.17116/endoskop20172363-8