Comparison of subxiphoid and lateral intercostal approaches for video-assisted thoracoscopic extended thymectomy: a retrospective cohort study.

BACKGROUND

Video-assisted thoracoscopic extended thymectomy (VATET) is widely used for thymoma. This study compared perioperative, neurological, and short-term oncologic outcomes between subxiphoid and lateral intercostal approaches.

METHODS

This retrospective cohort study included 168 patients who underwent VATET between January 2020 and May 2024. Patients were divided into the subxiphoid approach group (SA, n = 85) and the lateral intercostal approach group (ICA, n = 83). Outcomes included intraoperative blood loss, postoperative hospital stay, drainage duration, hospitalization costs, postoperative pain assessed by the visual analogue scale (VAS), complications graded using the Clavien-Dindo classification, histopathological findings, neurological outcomes assessed using Myasthenia Gravis Foundation of America Post-Intervention Status (MGFA-PIS), and thymoma recurrence. Multivariable logistic regression identified factors associated with prolonged hospitalization.

RESULTS

Baseline characteristics were comparable (P > 0.05), and histopathological features were similar between groups. Compared with the SA group, the ICA group had lower intraoperative blood loss, shorter postoperative stay, shorter drainage duration, and lower hospitalization costs (all P < 0.05). VAS scores on postoperative days 1, 3, and 7 were lower in the SA group (all P < 0.001). Complication rates were comparable (8.24% vs. 6.02%, P > 0.05). Neurological outcomes in myasthenia gravis were similar between groups. Thymoma recurrence occurred in two patients in each group.

CONCLUSION

Both approaches are safe and feasible for VATET. The lateral intercostal approach improves operative efficiency, whereas the subxiphoid approach reduces early postoperative pain without affecting neurological or short-term oncologic outcomes.