title: [Perioperative Outcomes and Long-term Survival in Clinically Early-stage Thymic  Malignancies: Video-assisted Thoracoscopic Thymectomy versus Open Approaches].
abstract: BACKGROUND
  Video-assisted thoracoscopic surgery (VATS) theoretically offers advantages over open thymectomy for clinically early-stage (Masaoka-Koga stage I and II) thymic malignancies. However, longterm outcomes have not been well studied. We compared the postoperative outcomes and survival from a cohort study based on the database of the Chinese Alliance for Research in Thymomas (ChART).
  
  
  METHODS
  Between 1994 and 2012, data of 1,117 patients having surgery for clinically early-stage (Masaoka-Koga stage I and II) tumors were enrolled for the study. Among them, 241 cases underwent VATS thymectomy (VATS group), while 876 cases underwent open thymectomy (Open group). Univariate analyses were used to compare the clinical character and perioperative outcomes between the two groups. And multivariate analysis was performed to determine the independent predictive factors for long-term survival.
  
  
  RESULTS
  Compared with the Open group, the VATS group had higher percentage of total thymectomy (80.5% vs 73.9%, P=0.028), resection rate (98.8% vs 88.7%, P<0.001) and less recurrence (2.9% vs 16.0%, P<0.001). Five-year overall survival was 92% after VATS and 92% after open thymectomy, with no significant difference between the two groups (P=0.15). However, 5-year disease free survival were 92% in VATS group and 83% in Open group (P=0.011). Cox proportional hazards model revealed that WHO classification, Masaoka-Koga stage and adjuvant therapy were independent predictive factors for overall survival, while surgical approach had no significant impact on long-term outcome.
  
  
  CONCLUSIONS
  This study suggests that VATS thymectomy is an effective approach for clinically early-stage thymic malignancies. And it may offer better perioperative outcomes, as well as equal oncological survival. .
authors.affiliation: Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
authors.forename: Zhitao
authors.initials: Z
authors.lastname: Gu
authors.affiliation: Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Jianyong
authors.initials: J
authors.lastname: Ding
authors.affiliation: Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Lijie
authors.initials: L
authors.lastname: Tan
authors.affiliation: Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Fu
authors.affiliation: Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Shen
authors.affiliation: Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China.
authors.forename: Yucheng
authors.initials: Y
authors.lastname: Wei
authors.affiliation: Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China.
authors.forename: Yongtao
authors.initials: Y
authors.lastname: Han
authors.affiliation: Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
authors.forename: Renquan
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China.
authors.forename: Yin
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China.
authors.forename: Ke-Neng
authors.initials: KN
authors.lastname: Chen
authors.affiliation: Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China.
authors.forename: Hezhong
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China.
authors.forename: Yongyu
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China.
authors.forename: Youbing
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Liewen
authors.initials: L
authors.lastname: Pang
authors.affiliation: Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China.
authors.forename: Zhentao
authors.initials: Z
authors.lastname: Yu
authors.affiliation: Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China.
authors.forename: Xinming
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China.
authors.forename: Yangchun
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
authors.forename: Wentao
authors.initials: W
authors.lastname: Fang
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D059035:Perioperative Period; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D013934:Thymectomy; D013945:Thymoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D013953:Thymus Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*