Subxiphoid versus Unilateral VATS Thymectomy for Thymomas: A Propensity Score-matching Analysis.

Abstract Background The appropriate surgical approach of VATS for early-stage thymoma remains unclear. The present study aimed to explore the safety and feasibility of subxiphoid and subcostal arch thoracoscopic thymectomy in comparison with unilateral thoracoscopic thymectomy for treatment of early-stage thymoma. Methods The outcomes of 237 patients without myasthenia gravis who had undergone thoracoscopic thymectomy for Masaoka stage I and II thymoma from January 2015 to May 2019 at our center were retrospectively evaluated (subxiphoid and subcostal arch approach: 39; unilateral VATS approach: 198). A propensity score-matching analysis was generated to control for selection bias due to nonrandom group assignment in a 1:1 manner. Results There was no surgery-related mortality in included patients. Matching of patients according to propensity score resulted in a cohort that consisted of 39 patients in both groups. Patients had similar clinical characteristics in both groups. Compared with those in the unilateral group, patients in the subxiphoid group yielded lower pain scores at 24- and 72-hours post-operation, respectively (P Conclusions Subxiphoid and subcostal arch thoracoscopic thymectomy for early-stage thymoma appears to be a safe and feasible procedure. It is considered to be less invasive as it may cause minimal postoperative pain compared to the unilateral VATS approach.