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H. Wang



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    MA 16 - Mediastinal, Tracheal and Esophageal Tumor: Multimodality Approaches (ID 675)

    • Event: WCLC 2017
    • Type: Mini Oral
    • Track: Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
    • Presentations: 1
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      MA 16.06 - Minimally Invasive Thoracoscopic Thymectomy for Early-Stage Thymomas: Modified Subxiphoid Approach Versus Unilateral Approach (ID 10081)

      15:45 - 17:30  |  Author(s): H. Wang

      • Abstract
      • Presentation
      • Slides

      Background:
      Conventionally, minimally invasive thymectomy for early-stage thymoma was performed via unilateral thoracoscopic approach. However it is sometimes criticized for bad exposure of anterior mediastinum which may be disadvantagous for the surgery. Recently, we attempted a modified subxiphoid thoracoscopic approach with novel sternal-elevating technique to reach better surgical exposure and less trauma.

      Method:
      From January 2015 to December 2016, a total of 83 consecutive patients with early-stage thymomas without myasthenia gravis were enrolled. Between them, 36 patients were performed thoracoscopic thymectomy via subxiphoid approach (Group S) . Three subxiphoid incisions (12mm*1, 5mm*2) with the aid of artificial CO~2~ pneumothorax (8cmH~2~O) were used. Additionally, we used the sternum-elevating device (Rul-tractor, USA) through the 3rd intercostal incision (5mm*1) beside the sternum. And the other 47 cases underwent conventional thymectomy via unilateral 3-port thoracoscopic approach (Group UL). The perioperative outcome of two groups were compared.

      Result:
      The two groups were comparable on patients[,] demographics. Conversion to open surgery occurred in 1 case (due to bleeding) in Group UL. Compared with Group UL, the patients in Group S had much shorter surgical duration [(63.5±10.7)min vs (87.7±13.1)min, p=0.000], much less pain scores (2.3±1.0 vs 3.1±1.30, p=0.002) and earlier pleural drainage removal [(1.6±0.6)d vs (2.3±0.9)d, p=0.000]. The complications were similar (5.6% vs 6.4%, p=0.758). No significant difference was found on the other outcomes between the two groups, including blood loss and postoperative hospital stay.

      Conclusion:
      This study suggests that the modified subxiphoid thoracoscopic approach seems to be more effective for thymectomy for early-stage thymomas. This novel approach could improve surgical exposure, accelerate the operative progress and result in less trauma and pain. It could be a promising refinement for future thymic surgery.

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