General thoracic and cardiovascular surgery · 2026
A comparison of robot-assisted thoracic surgery and median sternotomy for the treatment of early-stage thymoma: a propensity score matching study.
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Takenaka Hirofumi, Mizuno Tetsuya, Nakanishi Keita, Kadomatsu Yuka, Ueno Harushi, Kato Taketo, Nakamura Shota, Chen-Yoshikawa Toyofumi Fengshi
Аннотация
OBJECTIVE: For early-stage thymoma, Robot-assisted approaches for early-stage thymomas have become widespread. This study aimed to compare the surgical and survival outcomes of median sternotomy and robot-assisted thoracic surgery in patients with early-stage thymoma.
METHODS: Between 2010 and 2024, 203 patients with Masaoka stage I or II thymoma underwent either robot-assisted thoracic surgery (n = 68) or median sternotomy (n = 135). The clinical characteristics, surgical findings, and postoperative outcomes of the two approaches were compared. Propensity score matching was performed to manage selection bias.
RESULTS: The baseline characteristics, including age, sex, smoking history, presence of myasthenia gravis, pulmonary function, clinical staging, and histological classification were not significantly different. Patients in the robot-assisted thoracic surgery group showed significantly lower fluorodeoxyglucose uptake on positron emission tomography and a smaller preoperative tumor size on computed tomography (P < 0.01). Intraoperative blood loss, drainage duration, postoperative hospital stay, and pathological tumor size were significantly lower in the robot-assisted thoracic surgery group (P < 0.01). In addition, this group had a significantly higher proportion of cases of early pathological Masaoka stage disease (P < 0.01). Overall survival and recurrence-free survival were comparable between the two groups. After propensity score matching, the 56 matched patient pairs demonstrated similar perioperative outcomes, overall survival, and recurrence-free survival.
CONCLUSIONS: Robot-assisted thoracoscopic surgery was associated with significantly less intraoperative blood loss, shorter duration of chest drain placement, and shorter postoperative hospital stays than median sternotomy. Robot-assisted thoracoscopic surgery may be considered an effective, minimally invasive approach for early-stage thymoma without impairing survival outcomes.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11748-026-02294-8.
METHODS: Between 2010 and 2024, 203 patients with Masaoka stage I or II thymoma underwent either robot-assisted thoracic surgery (n = 68) or median sternotomy (n = 135). The clinical characteristics, surgical findings, and postoperative outcomes of the two approaches were compared. Propensity score matching was performed to manage selection bias.
RESULTS: The baseline characteristics, including age, sex, smoking history, presence of myasthenia gravis, pulmonary function, clinical staging, and histological classification were not significantly different. Patients in the robot-assisted thoracic surgery group showed significantly lower fluorodeoxyglucose uptake on positron emission tomography and a smaller preoperative tumor size on computed tomography (P < 0.01). Intraoperative blood loss, drainage duration, postoperative hospital stay, and pathological tumor size were significantly lower in the robot-assisted thoracic surgery group (P < 0.01). In addition, this group had a significantly higher proportion of cases of early pathological Masaoka stage disease (P < 0.01). Overall survival and recurrence-free survival were comparable between the two groups. After propensity score matching, the 56 matched patient pairs demonstrated similar perioperative outcomes, overall survival, and recurrence-free survival.
CONCLUSIONS: Robot-assisted thoracoscopic surgery was associated with significantly less intraoperative blood loss, shorter duration of chest drain placement, and shorter postoperative hospital stays than median sternotomy. Robot-assisted thoracoscopic surgery may be considered an effective, minimally invasive approach for early-stage thymoma without impairing survival outcomes.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11748-026-02294-8.