title: Early and mid-term outcomes of trans-sternal and video-assisted thoracoscopic surgery for thymoma.
abstract: OBJECTIVE
  Video-assisted thoracoscopic surgery (VATS) for thymoma has uncertain safety and effectiveness in comparison with trans-sternal resection. This feasibility study compared short- and mid-term outcomes for patients undergoing these two procedures, highlights weaknesses in current research and makes recommendations for long-term technological evaluations in this field.
  
  
  METHODS
  Consecutive thymoma cases between 2004 and 2010 were identified. Patients were divided into two groups according to surgical approach (Group I trans-sternal; Group II VATS) and comparisons were made between groups. The primary outcome was overall survival. Secondary outcomes included operative morbidity and mortality, hospital stay, recurrence rate and disease-free survival.
  
  
  RESULTS
  Thirty-nine patients were included (Group I: n = 22 vs Group II: n = 17). There were no differences between groups at baseline for all measured covariates. No deaths occurred within 30 days of surgery. More patients in Group I developed complications (Group I: n = 10 vs Group II: n = 3; P = 0.093), while hospital stay was shorter in Group II (Group I: 6.4 ± 4.6 days vs Group II: 4.4 ± 1.8 days; P = 0.030). Five-year overall survival (Group I: 93.8 ± 6.1% vs Group II: 83.3 ± 11.2%; P = 0.425), 5-year disease-free survival (Group I: 71.0 ± 15.3% vs Group II: 83.3 ± 11.2%; P = 0.827) and recurrence rates at final follow-up (Group I: n = 2 vs Group II: n = 1; P = 0.363) were similar between the groups.
  
  
  CONCLUSIONS
  VATS thymectomy for thymoma is feasible, safe and has comparable mid-term oncological outcomes to trans-sternal thymectomy. Future research is required to evaluate long-term oncological outcomes of VATS thymectomy for thymoma in national registries and randomized, controlled trials.
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, UK imthiazmanoly@gmail.com.
authors.forename: Imthiaz
authors.initials: I
authors.lastname: Manoly
authors.affiliation: Centre for Surgical Research, University of Bristol, Bristol, UK.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Whistance
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, UK.
authors.forename: Rahul
authors.initials: R
authors.lastname: Sreekumar
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, UK.
authors.forename: Saud
authors.initials: S
authors.lastname: Khawaja
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, UK.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Horton
authors.affiliation: Medanta, The Medicity, Gurgaon, India.
authors.forename: Ali Zamir
authors.initials: AZ
authors.lastname: Khan
authors.affiliation: University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Casali
authors.affiliation: St James University Hospitals, Leeds, UK.
authors.forename: James A
authors.initials: JA
authors.lastname: Thorpe
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, UK.
authors.forename: Khalid
authors.initials: K
authors.lastname: Amer
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, UK.
authors.forename: Edwin
authors.initials: E
authors.lastname: Woo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008479:Mediastinal Neoplasms / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D013934:Thymectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D013945:Thymoma / Q000601:surgery*; D016896:Treatment Outcome
keywords: Mediastinal tumours; Thoracoscopy/VATS; Thymectomy; Thymoma