Subxiphoid versus lateral intercostal uniportal thoracoscopic thymectomy: a propensity score matching study / 中华胸心血管外科杂志

ABSTRACT

Objective:To investigate the advantages and safety of subxiphoid uniportal thoracoscopic thymectomy.Methods:From October 2014 to December 2019, a total of 308 patients diagnosed with early stage thymic epithelial tumor underwent uniportal thoracoscopic thymectomy were included. Subxiphoid group including 40 males and 37 females, aged 32-80 years old, mean age(58.0±11.8)years old. Intercostal group including 114 males and 117 females, aged 25-78 years old, mean age(54.8±11.4)years old. Short-term and long-term postoperative pain scores was compared in a propensity score matching analysis.Results:Propensity score analysis revealed that 62 patients treated with the subxiphoid approach and 62 patients treated with the lateral intercostal approach had the same baseline characteristics. There were no significant differences in lesion size, stage, pathological type, intraoperative blood loss, postoperative drainage volume and postoperative hospital stay between the two groups( P>0.05). Compared with those in the intercostal group, patients in the subxiphoid group yielded lower pain scores on the first day after operation and less patients with postoperative pain lasting more than 3 months. Patients required for additional analgesic therapy in subxiphoid group was less than intercostal group. One patient in subxiphoid group developed myasthenia after operation, which prolonged the duration of mechanical ventilation. No serious perioperative complications and death occurred in other patients. Conclusion:Subxiphoid uniportal thoracoscopic thymectomy is safe and feasible, it has the advantages of no injury to intercostal nerve and less short-term and long-term postoperative pain compared with intercostal approach.