Clinical efficacy of robot-assisted thymectomy for large thymomas: a dual analysis of national and single-institution data.

BACKGROUND

Robot-assisted thymectomy (RAT) has been widely accepted due to its safety and feasibility. However, the optimal approach for large thymomas remains unclear. This study compares peri-operative and long-term oncological outcomes of RAT and open thymectomy (OT) for large thymomas.

METHODS

From the National Cancer Database (NCDB), 1,592 patients with thymomas >4 cm who underwent RAT (n=259, 16.3%) or OT (n=1,333, 83.7%) between 2010 and 2017 were identified. Tumor size was categorized as 4-5 cm, >5-6 cm, and >6 cm. A propensity-score-matched cohort analysis assessed tumor size, operative approach, and overall survival (OS) using Cox proportional hazards models and Kaplan-Meier survival curves. A single-institutional dataset of thymectomies for thymomas >5 cm (2008-2023) was similarly queried.

RESULTS

Both RAT and OT groups had similar R0 rates and peri-operative outcomes from the NCDB. The matched cohort (n=500, 50% RAT) demonstrated comparable OS between groups. A higher proportion of the African American and uninsured/Medicaid patients tended to receive OT, while insured or white patients received RAT. Institutional analysis of 43 thymectomy patients with >5 cm thymoma (RAT: n=21, OT: n=22) showed no significant differences in demographics, tumor stage, R0 rate, OS, and recurrence-free survival. RAT had fewer postoperative complications (4.8% vs. 31.8%, P=0.02) and shorter hospital stays (2.1±2.3 vs. 4.3±2.3 days, P<0.01).

CONCLUSIONS

RAT is associated with fewer complications and shorter hospital stays while maintaining comparable OS to OT for large thymomas. Socioeconomic and racial disparity continues to exist in RAT access among those with limited insurance and the African American population.