Asian journal of endoscopic surgery · 2026
Associations Between Tumor-Left Brachiocephalic Vein Distance and Operative Time in Minimally Invasive Subxiphoid Surgery for Thymoma.
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Kimura Toru, Miyashita Yudai, Nagata Hideki, Kimura Kenji, Kanou Takashi, Ose Naoko, Shintani Yasushi
Аннотация
INTRODUCTION: Tumor proximity to the left brachiocephalic vein (LBCV) may affect vascular exposure and dissection during the subxiphoid approach (SXA). We investigated the association between tumor-LBCV distance and operative time in patients undergoing subxiphoid robot-assisted or video-assisted thoracoscopic surgery for thymoma.
METHODS: Consecutive patients who underwent minimally invasive SXA for thymoma between 2019 and 2024 were retrospectively reviewed. The shortest tumor-LBCV distance (d-LBCV) was measured on preoperative computed tomography. Associations of d-LBCV and tumor size with operative time were evaluated using correlation, interaction, and multivariable linear regression analyses.
RESULTS: Among 64 patients with clinical Stage I thymoma without radiological evidence of vascular invasion, 45 and 19 underwent robot- and video-assisted thoracoscopic surgery, respectively. Overall, shorter d-LBCV (r = -0.357, p = 0.0037) and larger tumor size (r = 0.328, p = 0.0082) were correlated with longer operative time. In multivariable analysis adjusting for tumor size, surgical platform, and surgical procedure, shorter d-LBCV remained significantly associated with longer operative time (regression coefficient, -7.62 min per 10-mm increase; 95% CI, -13.21 to -2.03; p = 0.008). Surgical procedure was also significantly associated with operative time, whereas tumor size and surgical platform were not. Although platform-specific analyses showed different association patterns, interaction analyses showed no significant differences between RATS and VATS for tumor size or d-LBCV.
CONCLUSION: Shorter d-LBCV was independently associated with longer operative time during minimally invasive SXA for thymoma, despite adjustment for tumor size, surgical platform, and surgical procedure. d-LBCV may provide useful anatomical information for preoperative planning; although further validation is required.
METHODS: Consecutive patients who underwent minimally invasive SXA for thymoma between 2019 and 2024 were retrospectively reviewed. The shortest tumor-LBCV distance (d-LBCV) was measured on preoperative computed tomography. Associations of d-LBCV and tumor size with operative time were evaluated using correlation, interaction, and multivariable linear regression analyses.
RESULTS: Among 64 patients with clinical Stage I thymoma without radiological evidence of vascular invasion, 45 and 19 underwent robot- and video-assisted thoracoscopic surgery, respectively. Overall, shorter d-LBCV (r = -0.357, p = 0.0037) and larger tumor size (r = 0.328, p = 0.0082) were correlated with longer operative time. In multivariable analysis adjusting for tumor size, surgical platform, and surgical procedure, shorter d-LBCV remained significantly associated with longer operative time (regression coefficient, -7.62 min per 10-mm increase; 95% CI, -13.21 to -2.03; p = 0.008). Surgical procedure was also significantly associated with operative time, whereas tumor size and surgical platform were not. Although platform-specific analyses showed different association patterns, interaction analyses showed no significant differences between RATS and VATS for tumor size or d-LBCV.
CONCLUSION: Shorter d-LBCV was independently associated with longer operative time during minimally invasive SXA for thymoma, despite adjustment for tumor size, surgical platform, and surgical procedure. d-LBCV may provide useful anatomical information for preoperative planning; although further validation is required.