Trends in Surgical Approach to Thymectomy: An Analysis of the National Cancer Database
Ariella Sarkissian, Heidi Reich, Taryne A. Imai, Fernando Espinoza-Mercado, Jerald D. Borgella, Harmik J. Soukiasian, Cedars-Sinai Medical Center, Los Angeles, CA, USA
OBJECTIVE: Recent paradigm shifts from open thymectomy to minimally invasive approaches has been demonstrated as more thoracic surgeons adopt video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS). This study evaluated trends in surgical approaches to thymectomy with a chronologic analysis of the National Cancer Database (NCDB).
METHODS: The NCDB was queried to identify all patients that underwent thymectomy from 2010-2015 for thymoma, thymic carcinoma and other less frequent thymic neoplasias. The chronologic trends from open thymectomy to minimally invasive thymectomy were analyzed using Cochran-Armitage trend analysis. The relationships between surgical approach and tumor size, as well as length of stay (LOS), were analyzed using Kruskal-Wallis tests.
RESULTS: A total of 3,147 patients underwent thymectomy. The frequency of RATS and VATS increased from 6.4% to 17.1% and 8.6% to 16.4%, respectively, whereas open thymectomy declined from 85.0% to 66.5% (p<0.001) (Figure 1A). Open thymectomy was the most common approach for all tumor sizes and was performed at increasing frequency relative to RATS or VATS for thymomas >7 cm (85.6%, p<0.001) (Figure 1B). The median LOS for RATS, VATS, and open approaches were 2.5 days (IQR 1-4 days), 3.0 days (IQR 2-4 days), and 4.0 days (IQR 3-6 days), respectively (p<0.001).
CONCLUSIONS: From 2010-2015, there was a significant increase in the adoption of VATS and RATS, corresponding with a decline in open thymectomy. The adoption rate of minimally invasive approaches was slowest for large tumors. RATS had the shortest LOS and open thymectomy had the longest LOS.
Figure 1A and 1B