Bilateral video-assisted thoracoscopic thymectomy for Masaoka stage IIIA thymomas.

BACKGROUND: Larger invasive thymomas are generally resected via an open approach with thoracotomy or sternotomy. Following accumulation of experience and modifications to the technique, certain invasive tumors can be safely resected by video-assisted thoracic surgery (VATS) without resorting to sternotomy.

PATIENTS AND METHODS: Thirteen consecutive patients with large invasive thymomas, who underwent bilateral VATS thymectomy, were analyzed retrospectively.

RESULTS: All patients underwent radical en bloc resection of the tumor and the involved structures, without breaching the tumor capsule or tumor seeding. In one patient, difficulties in removal of the tumors from the left brachiocephalic vein necessitated conversion to an open approach with minithoracotomy. No procedure-related hemorrhage occurred. The average operation time, including the case requiring conversion, was 132 minutes. The mean postoperative hospital stay was 4.7 days. There were no perioperative deaths. All patients completed follow up, with a mean duration of 17.4 months. Follow-up chest computed tomography showed no cases of recurrence.

CONCLUSION: With proper patient selection, preoperative planning, and a standardized approach to the operative method, we believe that bilateral VATS thymectomy can be a safe and effective procedure, and may provide an attractive alternative approach to median sternotomy.