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. 2020 Oct;168(4):737-742.
doi: 10.1016/j.surg.2020.04.037. Epub 2020 Jul 5.

Comparative effectiveness and cost-efficiency of surgical approaches for thymectomy

Bartlomiej Imielski  1 , Chitaru Kurihara  1 , Adwaiy Manerikar  1 , Satya Chaudhary  1 , Susan Kosterski  1 , David Odell  1 , Samuel Kim  1 , Ankit Bharat  2
Affiliations

Comparative effectiveness and cost-efficiency of surgical approaches for thymectomy

Bartlomiej Imielski et al. Surgery. 2020 Oct.

Abstract

Background: We compared the clinical outcomes and cost-efficiency of surgical approaches (sternotomy-open, video assisted thoracoscopic surgery, and robotic assisted thoracic surgery) for thymectomy.

Methods: This is a retrospective review of 220 consecutive patients who underwent thymectomy between January 1, 2007, and January 31, 2017. Surgical approach was determined by the surgeon, but we only included cases that could be resected using any of the 3 approaches.

Results: Open approach was used in 69 patients, whereas minimally invasive technique was used in 151 (97, video assisted thoracoscopic surgery; 54, robotic assisted thoracic surgery). Open surgery was associated with greater total hospital cost ($22,847 ± $20,061 vs $14,504 ± $10,845, P < .001). Open group also revealed longer duration of intensive care unit (1.2 ± 2.8 vs 0.2 ± 1.3 days, P < .001) and hospital stay (4.3 ± 4.0 vs 2.0 ± 2.6 days, P < .001). There were no differences in major adverse clinical outcomes. Long-term recurrence-free survival after resection of thymoma was similar between the groups.

Conclusion: Minimally invasive techniques were equally efficacious compared with the open approach in the resection of the thymus. Additionally, their use was associated with decreased hospital duration of stay and reduced cost. Hence the use of minimally invasive approaches should be encouraged in the resection of thymus.

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Conflict of interest statement

COI/ Disclosures

The authors have no related conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Kaplan Meyer curve comparing recurrence-free survival between the open vs. minimally invasive surgical cohorts.
Figure 2.
Figure 2.
Kaplan Meyer curve comparing recurrence-free survival between the VATS and RATS surgical cohorts.
See this image and copyright information in PMC

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