Abstract
Background
The continuous evolvement of minimally invasive thymectomy over the last decades has potential advantages over trans-sternal thymectomy with similar oncologic outcomes of thymoma and complete remission for myasthenia gravis patients. A variety of different minimally invasive approaches have been described previously. The aim of this article is to present our subxiphoid and subcostal approaches in thymectomy for patients with myasthenia gravis and thymomas and to investigate the early surgical outcomes of these patients.
Methods
A retrospective analysis was performed of 95 patients who underwent thymectomy via a subxiphoid and subcostal approach for MG and/or thymoma at our department during the period of 2015 to 2017. The clinical characteristics and early surgical outcomes of these patients were reviewed and analyzed.
Results
Complete thymectomy and extended thymectomy was accomplished through the subxiphoid and subcostal approach in 93 of the 95 (97.9%) patients. Two patients (3.2%) required conversion to sternotomy for the invasion of a thymoma. The mean operative time was 109 min (range 70–170 min), with the mean estimated blood loss of 47 ml (range 20–350 ml). Postoperative complications included two cases of myasthenic crisis: one case of pleural effusion and one case of wound infection. In a mean follow-up of 31 months no patients showed recurrence of the tumor. In 41 MG patients followed up for 31 months, the improvement rate was 87.8% and the rate of complete remission was 29.3%.
Conclusion
Subxiphoid and subcostal thoracoscopic thymectomy may be a safe and feasible approach for treating MG and anterior mediastinal tumors



Similar content being viewed by others
Explore related subjects
Discover the latest articles and news from researchers in related subjects, suggested using machine learning.References
Zielinski M et al (2004) Transcervical-subxiphoid-videothoracoscopic "maximal" thymectomy–operative technique and early results. Ann Thorac Surg 78(2):404–409
Rea F et al (2004) Long-term survival and prognostic factors in thymic epithelial tumours. Eur J Cardiothorac Surg 26(2):412–418
Batirel HF (2018) Minimally invasive techniques in thymic surgery: a worldwide perspective. J Vis Surg 4:7
Cooper JD et al (1988) An improved technique to facilitate transcervical thymectomy for myasthenia gravis. Ann Thorac Surg 45(3):242–247
Landreneau RJ et al (1992) Thoracoscopic resection of an anterior mediastinal tumor. Ann Thorac Surg 54(1):142–144
Kido T et al (1999) Resection of anterior mediastinal masses through an infrasternal approach. Ann Thorac Surg 67(1):263–265
Marulli G et al (2012) Robot-aided thoracoscopic thymectomy for early-stage thymoma: a multicenter European study. J Thorac Cardiovasc Surg 144(5):1125–1130
Suda T et al (2016) Thymectomy via a subxiphoid approach: single-port and robot-assisted. J Thorac Dis 8(Suppl 3):S265–S271
Lu Q et al (2018) Subxiphoid and subcostal arch "Three ports" thoracoscopic extended thymectomy for myasthenia gravis. J Thorac Dis 10(3):1711–1720
Detterbeck FC et al (2014) The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol 9(9 Suppl 2):S65–72
Rosai J, S.L., Histological typing of tumours of the thymus. 2nd ed. World Health Organization international histological classification of tumours. 1999, New York: Springer. 5–23.
Jaretzki A et al (2000) Myasthenia gravis: recommendations for clinical research standards Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Ann Thorac Surg 70(1):327–334
Blalock A et al (1939) Myasthenia gravis and tumors of the thymic region: report of a case in which the tumor was removed. Ann Surg 110(4):544–561
Friedant AJ et al (2016) Minimally Invasive versus Open Thymectomy for Thymic Malignancies: Systematic Review and Meta-Analysis. J Thorac Oncol 11(1):30–38
Suda T et al (2016) Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: initial resultsdagger. Eur J Cardiothorac Surg 49(Suppl 1):i54–i58
Caronia FP et al (2015) Uniportal bilateral video-assisted thoracoscopic extended thymectomy for myasthenia gravis: A case report. J Thorac Cardiovasc Surg 150(1):e1–3
Hsu CP et al (2004) Comparison between the right side and subxiphoid bilateral approaches in performing video-assisted thoracoscopic extended thymectomy for myasthenia gravis. Surg Endosc 18(5):821–824
Suda T et al (2012) Single-port thymectomy through an infrasternal approach. Ann Thorac Surg 93(1):334–336
Takeo S et al (2011) Outcome of an original video-assisted thoracoscopic extended thymectomy for thymoma. Ann Thorac Surg 92(6):2000–2005
Ruffini E et al (2018) Optimal surgical approach to thymic malignancies: New trends challenging old dogmas. Lung Cancer 118:161–170
Toker A et al (2011) Standard terms, definitions, and policies for minimally invasive resection of thymoma. J Thorac Oncol 6(7 Suppl 3):S1739–S1742
Odaka M et al (2010) Unilateral thoracoscopic subtotal thymectomy for the treatment of stage I and II thymoma. Eur J Cardiothorac Surg 37(4):824–826
Nakagawa K et al (2016) Is Thymomectomy Alone Appropriate for Stage I (T1N0M0) Thymoma? Results of a Propensity-Score Analysis. Ann Thorac Surg 101(2):520–526
Gu Z et al (2016) Thymectomy versus tumor resection for early-stage thymic malignancies: a Chinese Alliance for Research in Thymomas retrospective database analysis. J Thorac Dis 8(4):680–686
Ng CS, Wan IY, Yim AP (2010) Video-assisted thoracic surgery thymectomy: the better approach. Ann Thorac Surg 89(6):S2135–S2141
Jaretzki A 3rd et al (1988) "Maximal" thymectomy for myasthenia gravis Results. J Thorac Cardiovasc Surg 95(5):747–757
Mack MJ et al (1996) Results of video-assisted thymectomy in patients with myasthenia gravis. J Thorac Cardiovasc Surg 112(5):1352–1359
DeFilippi VJ, Richman DP, Ferguson MK (1994) Transcervical thymectomy for myasthenia gravis. Ann Thorac Surg 57(1):194–197
Nussbaum MS et al (1992) Management of myasthenia gravis by extended thymectomy with anterior mediastinal dissection. Surgery 112(4):681–687
Savcenko M et al (2002) Video-assisted thymectomy for myasthenia gravis: an update of a single institution experience. Eur J Cardiothorac Surg 22(6):978–983
Funding
Funding was provided by Wujieping (Grant Number 180204).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Author Xiaofeng Chen, Qinyun Ma, Xuan Wang, An Wang, and Dayu Huang have no conflicts of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Chen, X., Ma, Q., Wang, X. et al. Subxiphoid and subcostal thoracoscopic surgical approach for thymectomy. Surg Endosc 35, 5239–5246 (2021). https://doi.org/10.1007/s00464-020-08022-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-020-08022-4