title: Robotic Resection of 3 cm and Larger Thymomas Is Associated With Low Perioperative Morbidity and Mortality.
abstract: OBJECTIVE
  The approach to thymoma resection has usually been determined by tumor size, although established guidelines do not exist. Minimally invasive approaches have been limited to tumors smaller than 5 cm, although 3 cm has been the suggested cutoff for performing an adequate oncologic procedure. No study has compared the perioperative outcomes of patients with 3 cm or larger tumors resected robotically versus sternotomy.
  
  
  METHODS
  We reviewed patients who underwent resection of 3 cm or larger thymomas from 2004 to 2014. Patients were divided based on approach: robotic and open thymectomy/thymomectomy.
  
  
  RESULTS
  Forty patients with tumors ranging from 3 to 13 cm were evaluated, 23 robotic and 17 open. Patient and tumor characteristics were similar. An R0 resection was primarily achieved: robotic, 91% (21/23); and open, 88% (15/17); P = 0.832. Adjuvant radiation rates were statistically equivalent: robotic, 17% (4/23) versus open, 41% (7/17); P = 0.191. Major postoperative complications were comparable: robotic, 4% (1/23) versus open, 29% (4/17); P = 0.184. Median chest tube duration was shorter for robotic (1 day) versus open (3 days); P = 0.001. The robotic approach had a shorter median intensive care unit stay compared to open (0 days vs 1 day); P = 0.024. The median hospital stay was shorter for robotic (2 days) versus open (5 days); P < 0.001.
  
  
  CONCLUSIONS
  In 3 cm or larger thymomas, robotic thymectomy is feasible based on the ability to achieve a complete resection with similar adjuvant radiation therapy rates. Perioperatively, robotic thymectomy is associated with lower morbidity; and shorter chest tube duration, intensive care unit stay, and hospital stay compared to open. However, oncologic outcomes are immature and require prolonged surveillance.
authors.affiliation: From the Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA USA.
authors.forename: Candice L
authors.initials: CL
authors.lastname: Wilshire
authors.forename: Eric
authors.initials: E
authors.lastname: Vallières
authors.forename: Dale
authors.initials: D
authors.lastname: Shultz
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Aye
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Farivar
authors.forename: Brian E
authors.initials: BE
authors.lastname: Louie
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation; D059035:Perioperative Period / Q000401:mortality*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods* / Q000401:mortality; D056346:Sternotomy / Q000379:methods*; D013934:Thymectomy / Q000295:instrumentation*; D013945:Thymoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D013953:Thymus Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D016896:Treatment Outcome