title: Long-term outcomes after thoracoscopic resection of stage I and II thymoma: a propensity-matched study.
abstract: OBJECTIVE
  The use of video-assisted thoracoscopic surgery (VATS) in patients with thymoma remains controversial. We sought to evaluate the perioperative and oncological outcomes after VATS resection for stage I and II thymoma and to compare the outcomes with those obtained after median sternotomy (MST).
  
  
  METHODS
  Between 1991 and 2007, a total of 140 patients with stage I and II thymoma underwent surgery at the Chang Gung Memorial Hospital. Of them, 58 underwent MST, 61 VATS, and 21 thoracotomy. Using a propensity score based on four variables (myasthenia gravis, tumor size on CT images, age, and Masaoka stage), 48 VATS-treated patients were matched to 48 patients who received MST. Outcomes compared included perioperative complications, length of stay, tumor recurrence, and survival.
  
  
  RESULTS
  No operative deaths occurred in this study. VATS was associated with fewer intraoperative blood loss, and more patients in the VATS group were extubated in the operating room after surgery compared with the MST group (37.5 vs. 12.5 %, respectively, P = 0.005). The mean length of stay was shorter in the VATS group than in the MST group (5.8 vs. 7 days, respectively; P = 0.008). After a median follow-up of 53 months, five patients developed recurrent tumors (four pleural and one pericardial). No statistically significant differences were found in the 5-year survival rates between the two study groups.
  
  
  CONCLUSIONS
  VATS appears feasible for patients with stage I and II thymoma and is associated with better perioperative outcomes than MST. The oncological outcomes are also similar.
authors.affiliation: Department of Thoracic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Yin-Kai
authors.initials: YK
authors.lastname: Chao
authors.forename: Yun-Hen
authors.initials: YH
authors.lastname: Liu
authors.forename: Ming-Ju
authors.initials: MJ
authors.lastname: Hsieh
authors.forename: Yi-Cheng
authors.initials: YC
authors.lastname: Wu
authors.forename: Tzu-Ping
authors.initials: TP
authors.lastname: Chen
authors.forename: Ming-Shian
authors.initials: MS
authors.lastname: Lu
authors.forename: Hung-I
authors.initials: HI
authors.lastname: Lu
authors.forename: Hui-Ping
authors.initials: HP
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D057216:Propensity Score; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D013906:Thoracoscopy / Q000379:methods; D013908:Thoracotomy / Q000401:mortality*; D013934:Thymectomy / Q000401:mortality*; D013945:Thymoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D013953:Thymus Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D055815:Young Adult