title: Determinants of Complete Resection of Thymoma by Minimally Invasive and Open Thymectomy: Analysis of an International Registry.
abstract: Minimally invasive thymectomy (MIT) is a surgical approach to thymectomy that has more favorable short-term outcomes for myasthenia gravis than open thymectomy (OT). The oncologic outcomes of MIT performed for thymoma have not been rigorously evaluated. We analyzed determinants of complete (R0) resection among patients undergoing MIT and OT in a large international database.
  
  
  
  The retrospective database of the International Thymic Malignancy Interest Group was queried. Chi-square and Wilcoxon rank sum tests, multivariate logistic regression models, and propensity matching were performed.
  
  
  
  A total of 2514 patients underwent thymectomy for thymoma between 1997 and 2012; 2053 of them (82%) underwent OT and 461 (18%) underwent MIT, with the use of MIT increasing significantly in recent years. The rate of R0 resection among patients undergoing OT was 86%, and among those undergoing MIT it was 94% (p < 0.0001). In propensity-matched MIT and OT groups (n = 266 in each group); however, the rate of R0 resection did not differ significantly (96% in both the MIT and OT groups, p = 0.7). Multivariate analyses were performed to identify determinants of R0 resection. Factors independently associated with R0 resection were geographical region, later time period, less advanced Masaoka stage, total thymectomy, and the absence of radiotherapy. Surgical approach, whether minimally invasive or open, was not associated with completeness of resection.
  
  
  
  The use of MIT for resection of thymoma has been increasing substantially over time, and MIT can achieve rates of R0 resection for thymoma similar to those achieved with OT.
authors: Baylor College of Medicine, Houston, Texas. Electronic address: bryan.burt@bcm.edu.
authors: Bryan M
authors: BM
authors: Burt
authors: Yale University, New Haven, Connecticut.
authors: Xiaopan
authors: X
authors: Yao
authors: Stanford University School of Medicine, Stanford, California.
authors: Joseph
authors: J
authors: Shrager
authors: Yale University, New Haven, Connecticut.
authors: Alberto
authors: A
authors: Antonicelli
authors: Stanford University School of Medicine, Stanford, California.
authors: Sukhmani
authors: S
authors: Padda
authors: University of California Davis Medical Center, Sacramento, California.
authors: Jonathan
authors: J
authors: Reiss
authors: Stanford University School of Medicine, Stanford, California.
authors: Heather
authors: H
authors: Wakelee
authors: Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors: Stacey
authors: S
authors: Su
authors: Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: James
authors: J
authors: Huang
authors: Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors: Walter
authors: W
authors: Scott
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009367:Neoplasm Staging; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D013934:Thymectomy / Q000379:methods*; D013945:Thymoma / Q000473:pathology / Q000601:surgery*; D013953:Thymus Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
keywords: Complete resection; Minimally invasive; R0; Thymectomy; Thymoma