ROBOT-ASSISTED THYMECTOMY FOR LARGE THYMOMAS: SURGICAL AND LONG-TERM ONCOLOGICAL OUTCOMES FROM A MULTICENTER STUDY
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Publication Date:
2024
Citation:
ROBOT-ASSISTED THYMECTOMY FOR LARGE THYMOMAS: SURGICAL AND LONG-TERM ONCOLOGICAL OUTCOMES FROM A MULTICENTER STUDY / D. Nachira, E. Meacci, L. Bertolaccini, P. Novellis, P. Bertoglio, A. De Palma, R. Romano, F. Raveglia, M. Chiappetta, M. Chiari, S. Maiorca, C. Scala, M. Petroncini, D. Brascia, G. Carleo, F. Spinelli, F. Petrella, D. Gavezzoli, P. Solli, G. Veronesi, L. Spaggiari, S. Margaritora. 32. ESTS Annual Meeting : 26-28 may Barcelona 2024.
abstract:
OBJECTIVES
This study aimed to evaluate surgical and oncological outcomes of Robot-assisted (RATS)
thymectomy in the treatment of large (diameter >5 cm) thymomas.
METHODS
Clinical data of 318 thymectomies for thymoma [117 (36.8%) for concomitant Myasthenia
Gravis (MG)], performed in 7 high volume centers from 2010 to 2023, were retrospectively
reviewed. Surgical outcomes were evaluated: 1.in the RATS group per thymoma size (<5 vs
>5 cm); 2.in large thymomas per surgical approach (RATS vs open/RATS vs VATS). KaplanMeier and Cox-regression analyses were used to identify prognostic factors for oncological
outcomes. To reduce any selection bias, a 1:1 propensity score match (PSM) analysis was
performed for large thymomas.
RESULTS
132 RATS thymectomies were performed: 59 (44.7%) for small [MG: 34 (57.6%)] and 73
(55.3%) for large [MG: 22 (30.1%)] thymomas. Conversion (p=0.48), significant complications
(p=0.26) and hospital stay (p=0.79) were similar in both groups.
Overall, 208 large thymomas were operated on: 73 (35.1%) RATS [MG: 22 (30.1%)], 118
(56.7%) open [MG: 38 (32.2%)] and 17 (8.2%) VATS (MG: 0%). More post-operative
complications (p<0.001) but similar major complications (p=0.11) and a longer in-hospital stay (p<0.001) were recorded in an open group compared to RATS for large thymomas without
differences in the MG population (p=0.77). While comparing RATS to the VATS group
(with a significant difference in MG between groups, p<0.001), no difference was recorded
in conversion (p=0.52), complications (p=0.75) and hospitalization (p=0.08). Five-year OS
(95% vs 85%, p=0.14) and DFS (86% vs 93%, p=0.18) of large thymomas were comparable
between RATS and the open group. Prognostic factors for oncological outcomes for large
thymomas were confirmed after PSM. Adjuvant radiotherapy was the only prognostic factor
(HR=6.11, 95%CI:1.27-29.40, p=0.02) affecting DFI, while no factor was confirmed for OS
at multivariable analysis.
CONCLUSIONS
RATS is a safe and effective approach for treating large thymomas.
This study aimed to evaluate surgical and oncological outcomes of Robot-assisted (RATS)
thymectomy in the treatment of large (diameter >5 cm) thymomas.
METHODS
Clinical data of 318 thymectomies for thymoma [117 (36.8%) for concomitant Myasthenia
Gravis (MG)], performed in 7 high volume centers from 2010 to 2023, were retrospectively
reviewed. Surgical outcomes were evaluated: 1.in the RATS group per thymoma size (<5 vs
>5 cm); 2.in large thymomas per surgical approach (RATS vs open/RATS vs VATS). KaplanMeier and Cox-regression analyses were used to identify prognostic factors for oncological
outcomes. To reduce any selection bias, a 1:1 propensity score match (PSM) analysis was
performed for large thymomas.
RESULTS
132 RATS thymectomies were performed: 59 (44.7%) for small [MG: 34 (57.6%)] and 73
(55.3%) for large [MG: 22 (30.1%)] thymomas. Conversion (p=0.48), significant complications
(p=0.26) and hospital stay (p=0.79) were similar in both groups.
Overall, 208 large thymomas were operated on: 73 (35.1%) RATS [MG: 22 (30.1%)], 118
(56.7%) open [MG: 38 (32.2%)] and 17 (8.2%) VATS (MG: 0%). More post-operative
complications (p<0.001) but similar major complications (p=0.11) and a longer in-hospital stay (p<0.001) were recorded in an open group compared to RATS for large thymomas without
differences in the MG population (p=0.77). While comparing RATS to the VATS group
(with a significant difference in MG between groups, p<0.001), no difference was recorded
in conversion (p=0.52), complications (p=0.75) and hospitalization (p=0.08). Five-year OS
(95% vs 85%, p=0.14) and DFS (86% vs 93%, p=0.18) of large thymomas were comparable
between RATS and the open group. Prognostic factors for oncological outcomes for large
thymomas were confirmed after PSM. Adjuvant radiotherapy was the only prognostic factor
(HR=6.11, 95%CI:1.27-29.40, p=0.02) affecting DFI, while no factor was confirmed for OS
at multivariable analysis.
CONCLUSIONS
RATS is a safe and effective approach for treating large thymomas.
IRIS type:
14 - Intervento a convegno non pubblicato
List of contributors:
D. Nachira, E. Meacci, L. Bertolaccini, P. Novellis, P. Bertoglio, A. De Palma, R. Romano, F. Raveglia, M. Chiappetta, M. Chiari, S. Maiorca, C. Scala, M. Petroncini, D. Brascia, G. Carleo, F. Spinelli, F. Petrella, D. Gavezzoli, P. Solli, G. Veronesi, L. Spaggiari, S. Margaritora
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