title: The oncological feasibility and limitations of video-assisted thoracoscopic thymectomy for early-stage thymomas.
abstract: OBJECTIVE
  Although video-assisted thoracoscopic thymectomy (VATS-Tx) for thymoma has been introduced, its oncological outcome remains unclear. Our institutional experience with early-stage thymoma was retrospectively reviewed to evaluate the oncological feasibility of thoracoscopic thymectomy.
  
  
  METHODS
  A retrospective review consisting of 74 patients with Masaoka Stage I and II thymomas who had undergone thymectomy was performed. Forty-five patients underwent thoracoscopic thymectomy, while 29 underwent thymectomy through the open sternotomy approach. The clinical factors associated with the surgical outcome, including tumour recurrence, were investigated.
  
  
  RESULTS
  Neither operative death nor major postoperative complications were observed. The median intraoperative blood loss and operative time of thoracoscopic thymectomy were 50 ml and 180 min, respectively. Among the patients with thymomas >5 cm, the number of patients with operative time >4 h was 9 of 26 (34.6%) in the thoracoscopic thymectomy and 1 of 21 (4.8%) in the open sternotomy groups. Pleural recurrence was observed in 3 (6.7%) patients with thymoma >5 cm only in the thoracoscopic thymectomy group. Tumour capsule injury by manipulation during the operation was recorded in 2 of these 3 patients. In 2 of the 3 cases who had tumours with cystic portions on computed tomography, a tumour capsule injury occurred due to manipulation during thoracoscopic thymectomy.
  
  
  CONCLUSIONS
  VATS-Tx for early-stage thymomas is feasible, while the indications should be carefully considered in patients with large or cystic tumours. The conventional open sternotomy approach could be recommended in patients with thymomas >5 cm to avoid capsule injury.
authors.affiliation: Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Kimura
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Inoue
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kadota
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shiono
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shintani
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nakagiri
authors.forename: Soichiro
authors.initials: S
authors.lastname: Funaki
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Sawabata
authors.forename: Masato
authors.initials: M
authors.lastname: Minami
authors.forename: Meinoshin
authors.initials: M
authors.lastname: Okumura
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D013934:Thymectomy / Q000009:adverse effects / Q000379:methods*; D013945:Thymoma / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D013953:Thymus Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Outcomes; Thoracoscopic surgery; Thymectomy; Thymoma