Management of thymic epithelial tumors more than 5 cm with subxiphoid robotic thymectomy: perioperative and mid-term outcomes.

To assess feasibility and oncological results of subxiphoid robotic thymectomy by comparing perioperative and survival outcomes between large (≥ 5 cm) and small (< 5 cm) thymic epithelial tumors (TETs). This retrospective research contained 145 patients with TETs undergoing subxiphoid robotic thymectomy between September 2016 and November 2022. Patients were assigned into large and small tumor group according to maximum diameter on chest CT. The large and small tumor groups included 51 and 94 patients respectively. All patients underwent R0 resection. Patients with large tumor group had prolonged surgical time (135 vs. 120 min, p = 0.005). Other characteristics including pathology, length of hospital stay, TNM stage and tumor invasion were not significantly different between groups. Median follow-up was 65 months. 62.8% of patients completed 5 years of follow-up. Five-year FFR (85.2% vs. 93.4%, p = 0.18), OS (92.6% vs. 95.5%, p = 0.75), and DFS (85.2% vs. 89.9%, p = 0.61) were comparable between large and small tumor groups. In contrast, FFR differed significantly by histotype (p = 0.0001). Among patients undergoing subxiphoid robotic thymectomy, there is no significant differences in survival outcomes over 5 years between large and small tumors.