A National Analysis of Open vs Minimally Invasive Thymectomy for Stage I-III Thymoma

Abstract Objective The oncologic efficacy of minimally invasive (MIS) thymectomy for thymoma is not well characterized. We compared short-term outcomes and overall survival between open and MIS (video-assisted thoracoscopic [VATS] and robotic) approaches using the National Cancer Data Base (NCDB). Methods Perioperative outcomes and survival of patients who underwent open versus MIS thymectomy for clinical stage I-III thymoma from 2010 to 2014 in the NCDB were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis. Predictors of MIS use were evaluated using multivariable logistic regression. Outcomes of surgical approach were evaluated using an intent-to-treat analysis. Results Of the 1,223 thymectomies that were evaluated, 317 (26%) were performed minimally invasively (141 VATS and 176 robotic). The MIS group had a shorter median (IQR) length of stay (LOS) when compared to the open group (3[2,4] days vs 4[3,6] days, p Conclusions In this national analysis, MIS thymectomy was associated with shorter LOS and was not associated with increased margin positivity, perioperative mortality, 30-day readmission rate, or reduced overall survival when compared with open thymectomy.