Associations Between Tumor-Left Brachiocephalic Vein Distance and Operative Time in Minimally Invasive Subxiphoid Surgery for Thymoma.

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.