PURPOSE: Optimal surgical approach to thymectomy is controversial. Current literature demonstrates thoracoscopic thymectomy (TT) to be as effective as sternotomy in patients with Myasthenia Gravis (MG). This study reviews our experience with TT to determine the efficacy of this procedure in patients with anterior mediastinal mass (AMM).
METHODS: IRB-approved retrospective review of 85 patients undergoing thymectomy between 1992–2007. 36 patients underwent TT and 49 underwent sternotomy. Preoperative diagnosis of AMM made via computed tomography (CT) scan. All data was collected from medical records.
RESULTS: Thirty-six patients underwent TT; 13 had preoperative diagnosis of MG, 20 AMM and 3 had both MG and AMM. 30 underwent a right-sided approach and 6 patients had a left port placed for improved left phrenic nerve visualization. All were completed thoracoscopically. Patients undergoing TT versus sternotomy were equally matched in age and comorbidities. There was no statistical difference in speicmen size removed. Statistical significance included shorter length of hospital stay for patients undergoing TT (2.83 vs 4.41 days, p=0.0009) and longer intraoperative time for TT (263.83 vs 160.93 min, p=0.0001). There were fewer morbidities in patients undergoing TT (8% vs 14%) and no mortalities. Of the 23 patients undergoing TT for AMM, pathology revealed benign thymic disease in 19 and thymoma less than 3.5cm in 4. Average follow up of 1.5 years demonstrated no recurrence.
CONCLUSION: TT is an efficacious technique for thymectomy in patients with MG as demonstrated in current literature. Here we conclude that TT is a favorable approach for both diagnostic and therapeutic intervention in patients with AMM. The greatest advantage of this procedure is optimal visualization of the thymus and surrounding structures via several 2cm incisions. This approach is associated with shorter hospital stay, less pain, improved cosmesis and minimal complications. Intraoperative time for our last 10 procedures has significantly decreased to under 3 hours. Early follow-up demonstrates no recurrence; however, longer follow-up is needed to confirm oncologic and neurological efficacy.
CLINICAL IMPLICATIONS: TT is a favorable approach in patients with AMM.
DISCLOSURE: Dana Telem, No Financial Disclosure Information; No Product/Research Disclosure Information