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Multi-institutional European experience of robotic thymectomy for thymoma

	author = {Giuseppe Marulli and Jos Maessen and Franca Melfi and Thomas A. Schmid and Marlies Keijzers and Olivia Fanucchi and Florian Augustin and Giovanni M. Comacchio and Alfredo Mussi and Monique Hochstenbag and Federico Rea},
	title = {Multi-institutional European experience of robotic thymectomy for thymoma},
	journal = {Annals of Cardiothoracic Surgery},
	volume = {5},
	number = {1},
	year = {2015},
	keywords = {},
	abstract = {Background: Robotic thymectomy for early-stage thymomas has been recently suggested as a technically sound and safe approach. However, due to a lack of data on long term results, controversy still exists regarding its oncological efficacy. In this multi-institutional series collected from four European Centres with high volumes of robotic procedures, we evaluate the results after robot-assisted thoracoscopic thymectomy for thymoma.
Methods: Between 2002 and 2014, 134 patients (61 males and 73 females, median age 59 years) with a clinical diagnosis of thymoma were operated on using a left-sided (38%), right-sided (59.8%) or bilateral (2.2%) robotic approach. Seventy (52%) patients had associated myasthenia gravis (MG).
Results: The average operative time was 146 minutes (range, 60-353 minutes). Twelve (8.9%) patients needed open conversion: in one case, a standard thoracoscopy was performed after robotic system breakdown, and in six cases, an additional access was required. Neither vascular and nerve injuries, nor perioperative mortality occurred. A total of 23 (17.1%) patients experienced postoperative complications. Median hospital stay was 4 days (range, 2–35 days). Mean diameter of resected tumors was 4.4 cm (range, 1–10 cm), Masaoka stage was I in 46 (34.4%) patients, II in 71 (52.9%), III in 11 (8.3%) and IVa/b in 6 (4.4%) cases. At last follow up, 131 patients were alive, three died (all from non-thymoma related causes) with a 5-year survival rate of 97%. One (0.7%) patient experienced a pleural recurrence.
Conclusions: Our data suggest that robotic thymectomy for thymoma is a technically feasible and safe procedure with low complication rates and short hospital stays. Oncological outcome appears to be good, particularly for early-stage tumors, but a longer follow-up period and more cases are necessary in order to consider this as a standard approach. Indications for robotic thymectomy for stage III or IVa thymomas are rare and should be carefully evaluated.},
	issn = {2225-319X},	url = {}