P29: Evolution of minimally invasive surgery in the management of thymic masses at a single institution

Background: Thymic masses may result due to benign or malignant processes. The optimal surgical approach in the management of these masses remains controversial. The aim of this study was to review our experience in surgical resection of thymic masses, and present outcomes from various surgical approaches.

Methods: A retrospective review was conducted on patients with surgically resected thymic masses from 2000 to 2014 at our institution. Data collected included: patients’ demographics, clinical presentation, myasthenia gravis, medical co-morbidities, radiological findings, histological types and stages. Surgical approaches and post-operative outcomes were also analyzed. Outcomes were stratified according to the main surgical approaches: open, video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS).

Results: Seventy-one patients were eligible for this study. Median age was 48 years (range: 18–78 years) and 37 were female. Forty-three patients had a diagnosis of myasthenia gravis and 17 patients received intra-venous immunoglobulin (IVIG) treatment pre-operatively. Other common medical co-morbidities were hypertension (n=22), hyperlipidaemia (n=19) and diabetes (n=9). Twenty patients underwent open surgery via median sternotomy (MS), 22 underwent VATS, and 29 had RATS. Median operative time was 100 minutes for both open and robotic surgery, and 143 minutes for VATS. There were three conversions from VATS to open surgery, but none for RATS. Post-operative complications occurred in four MS and three VATS patients. There was no mortality. Median length of stay was 5 days for open surgery, 4 days for VATS and 2 days for RATS. Thymomas were the most common histological diagnosis (n=34).

Conclusions: Our study demonstrates that minimally invasive approaches (VATS and RATS) for thymic masses are safe and associated with low morbidity and mortality. RATS is now the approach of choice at our Institution.

Keywords: Robotic surgery; video-assisted thoracoscopic surgery (VATS); robotic assisted thoracic surgery (RATS); thymoma; thymic mass