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Thoracoscopic thymectomy versus open thymectomy for the treatment of thymoma: A meta-analysis

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Abstract

Background

Some studies compared the safety and efficacy of thoracoscopic thymectomy (OT) with open thymectomy (TT) in the treatment of thymoma, but the results remained controversial. This meta-analysis was designed to determine the safety and efficacy of thoracoscopic thymectomy in comparison with open thymectomy in the treatment of thymoma.

Methods

Relevant studies were searched in databases of PubMed, EMBASE and Web of Science. Comparative studies of thoracoscopic thymectomy and open thymectomy in the treatment of thymoma were included. Both short-term perioperative and long-term oncologic outcomes were analyzed.

Results

14 Eligible studies were identified through electronic databases. Our analysis suggested, when compared with open thymectomy, patients having thoracoscopy might benefit from less blood loss (p = 0.004), lower blood transfusion rate (p = 0.02), shorter mean duration of chest tube (p = 0.002), hospital stay (p < 0.001) and lower complication (p = 0.03). There was no statistical difference in 5-year OS rate (p = 0.14) and DFS/RFS rate (p = 0.07) between two groups.

Conclusion

Our study indicated that thoracoscopic thymectomy could become a valid alternative to open thymectomy in selected patients with thymoma.

Introduction

Thymoma is a relatively rare tumor, with the overall incidence of 0.15 cases per 100,000.1 It accounts for 20% of the overall mediastinal tumors and 50% of all the anterior mediastinal tumors, and is considered to be the most common tumor of the anterior mediastinum.2, 3 Thymoma is an indolent tumor, with a tendency toward local recurrence rather than metastasis.4 Surgery was still considered as the mainstay treatment of thymoma, especially for early stage disease. As reported that the 5-year overall survival rates for completely resected stage I and stage II thymoma are notable, ranging from 89% to 100% and 71% to 95%, respectively. For advanced thymoma, debulking surgery may perhaps improve overall survival.5, 6 Nowadays, the progress in technology and instruments has enabled thoracoscopic thymectomy (TT) for thymoma. However, the safety and long-term oncological outcomes of VATS are still under the concern of thoracic surgeons. Some studies compared the safety and efficacy of thoracoscopic thymectomy (OT) with open thymectomy (TT), but the results remains controversial. Due to the limited sample size and static power in individual study, a meta-analysis is necessary to evaluate safety and efficacy of TT procedure in comparison with OT for patients with thymoma.

Section snippets

Literature search

A comprehensive literature search was conducted in the databases of PubMed, EMBASE and Web of Science. The last search time was Oct 31, 2015. The following terms and combinations were used to identify studies: video-assisted thoracic surgery; VATS; thoracoscopy; thymectomy; minimal invasive surgery and thymoma. Furthermore, references of retrieved articles and reviews were manually screened for additional studies.

Inclusion and exclusion criteria

The inclusion criteria were applied to identify the eligible studies: (1)

Eligible studies

Fig. S1 (Supplementary files, Fig. S1) summarized our process of articles selection. The initial research yielded 224 potential articles, after reading the titles and abstracts, 192 studies were excluded because they were obviously irrelevant to our study design. The other 32 studies with full texts were carefully assessed for eligibility. As a results, 18 studies were excluded for following reasons: six studies were non-comparative studies that they only reported VATS groups, five studies did

Discussion

Advocates of VATS emphasize that this minimally invasive procedure is associated with less tissue trauma, lower complication rates, reduced postoperative pain and scarring, and shorter hospital stay. The overall advantage of thoracoscopy over thoracotomy in terms of patient recovery was fairly well established in VATS lobectomy, VATS assisted esophagectomy and other thoracic procedures.26, 27 Our analysis suggested that when compared with conventional OT approach, TT was associated with less

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