Journal of thoracic disease · 2026
Comparative outcomes of robotic- and video-assisted thoracoscopic surgery in thymectomy: a systematic review of implications for myasthenia gravis remission and long-term oncology.
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Barnawi Anas B, Hajjar Waseem M, Almaymuni Adel D, Almudawi Abdulrahman Abdullah, Alanazi Abdulmohsen S, Bazarah Razan S, AlAhmari Osama Mushabbab, Al-Ahmari Osama Thamer, Alhassoun Abdullah Ibrahim, Alshehri Abdulelah F
Аннотация
BACKGROUND: Thymectomy is a cornerstone in the management of thymic epithelial tumors and myasthenia gravis (MG). While minimally invasive techniques like video-assisted thoracoscopic surgery (VATS) have gained prominence, robotic-assisted thoracoscopic surgery (RATS) has emerged as a technically advanced alternative. However, comparative long-term oncological outcomes between RATS and VATS remain underexplored. This review aims to compare RATS and VATS thymectomy regarding long-term outcomes, perioperative results, and cost.
METHODS: A systematic review was conducted following PRISMA guidelines, with a protocol registered in PROSPERO (CRD420251126351). PubMed/MEDLINE, Web of Science, and Cochrane Library were searched for comparative studies reporting long-term outcomes (≥12 months follow-up) of RATS versus VATS thymectomy. Risk of bias was assessed using the Newcastle-Ottawa Scale.
RESULTS: Three retrospective cohort studies (430 patients: 181 RATS, 249 VATS) were included. No significant differences were found in long-term oncological outcomes: 5-year progression-free survival (RATS 87.7% vs. VATS 90.6%, P=0.504) and overall survival (87.7% vs. 92.2%) were comparable. Recurrence and reoperation rates were low and similar between groups. In MG patients, RATS was associated with a higher rate of complete stable remission (26% vs. 18%, P=0.06) and was an independent predictor of remission (hazard ratio: 0.472, P=0.049). Perioperatively, RATS demonstrated advantages including lower conversion rates (3% vs. 15%, P=0.03), shorter operative time (median 100 vs. 120 min, P=0.039), and reduced hospital stay (mean 1.3 vs. 2.4 days, P=0.01). Complication rates were similarly low. However, RATS was significantly more costly (¥68,122 vs. ¥37,886, P<0.001).
CONCLUSIONS: RATS and VATS thymectomy yield equivalent long-term oncological outcomes. RATS offers superior perioperative recovery and may enhance neurological remission in MG patients, but at a significantly higher cost. The choice of technique should consider clinical context, surgeon expertise, and economic factors.
METHODS: A systematic review was conducted following PRISMA guidelines, with a protocol registered in PROSPERO (CRD420251126351). PubMed/MEDLINE, Web of Science, and Cochrane Library were searched for comparative studies reporting long-term outcomes (≥12 months follow-up) of RATS versus VATS thymectomy. Risk of bias was assessed using the Newcastle-Ottawa Scale.
RESULTS: Three retrospective cohort studies (430 patients: 181 RATS, 249 VATS) were included. No significant differences were found in long-term oncological outcomes: 5-year progression-free survival (RATS 87.7% vs. VATS 90.6%, P=0.504) and overall survival (87.7% vs. 92.2%) were comparable. Recurrence and reoperation rates were low and similar between groups. In MG patients, RATS was associated with a higher rate of complete stable remission (26% vs. 18%, P=0.06) and was an independent predictor of remission (hazard ratio: 0.472, P=0.049). Perioperatively, RATS demonstrated advantages including lower conversion rates (3% vs. 15%, P=0.03), shorter operative time (median 100 vs. 120 min, P=0.039), and reduced hospital stay (mean 1.3 vs. 2.4 days, P=0.01). Complication rates were similarly low. However, RATS was significantly more costly (¥68,122 vs. ¥37,886, P<0.001).
CONCLUSIONS: RATS and VATS thymectomy yield equivalent long-term oncological outcomes. RATS offers superior perioperative recovery and may enhance neurological remission in MG patients, but at a significantly higher cost. The choice of technique should consider clinical context, surgeon expertise, and economic factors.