AB018. OS04.04. Is video-assisted thymectomy appropriate for large thymomas? Results of a propensity score matching analysis

Abstract OBJECTIVES Video-assisted thoracoscopic thymectomy is becoming the preferable approach for early-stage thymoma. However, large thymomas are still recognized as a relative contraindication due to the possible risk of incomplete resection or capsular disruption. Thus, the aim of this study is to evaluate the feasibility of video-assisted thoracoscopic thymectomy for large thymomas. METHODS Patients diagnosed with Masaoka stage I–IV thymoma between April 2001 and December 2018 were retrospectively reviewed. All patients were divided into 2 groups: thymoma <5.0 cm (group A) and thymoma ≥5.0 cm (group B). Propensity score matching analysis was performed to compare postoperative results. Recurrence-free survival and overall survival were compared for oncological evaluation. RESULTS A total of 346 patients were included in this study. In the propensity score matching analysis, 126 patients were included both in group A and group B. There was no significant difference between these 2 groups in terms of the R0 resection rate (95.2% vs 94.4%, P = 1.000), conversion rate (1.6% vs 3.2%, P = 0.684), operation time (119.4 ± 48.4 vs 139.1 ± 46.6 min, P = 0.955), blood loss (93.2 ± 231.7 vs 100.5 ± 149.3 ml, P = 0.649), duration of chest drainage (2.7 ± 1.6 vs 2.8 ± 2.0 days, P = 0.184), length of hospitalization (5.0 ± 3.9 vs 5.2 ± 2.9 days, P = 0.628) or postoperative complications (5.9% vs 8.5%, P = 0.068). There was no significant difference between these 2 groups in terms of the overall survival (P = 0.271) and recurrence-free survival (P = 0.288). CONCLUSIONS Video-assisted thoracoscopic thymectomy is a safe and effective approach for large thymomas (≥5 cm) with comparable surgical and oncological results.

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Surgery performed at night by continuously working surgeons contributes to a higher incidence of intraoperative complications in video-assisted thoracoscopic pulmonary resection: a large monocentric retrospective study

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz253 ◽

2019 ◽

Cited By ~ 2

Author(s):

Chunji Chen ◽

Xiaofeng Zhang ◽

Chang Gu ◽

Yiyang Wang ◽

Kun Liu ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Pulmonary Resection ◽

Thoracoscopic Surgery ◽

Intraoperative Complications ◽

Working Hours ◽

Night Time ◽

Propensity Score Matching Analysis ◽

Video Assisted ◽

Independent Risk Factors

Abstract OBJECTIVES Our goal was to assess the influence of working hours and working at night on intraoperative complications on surgeons conducting video-assisted pulmonary resections. METHODS We identified all patients who underwent video-assisted thoracoscopic surgery (VATS) in Shanghai Chest Hospital from January 2015 to April 2017. Univariable and multivariable logistic analyses were used to analyse independent risk factors for intraoperative complications. A 1:4 propensity score matching analysis was conducted to verify those results. RESULTS A total of 15 767 patients who underwent VATS pulmonary resection were included in this study. Among them, 15 280 patients (96.1%) were operated on during daytime working hours and 487 (3.1%) at night. A total of 203 (1.3%) intraoperative complications occurred. Vascular injury was the main cause of intraoperative complications, accounting for 92.1% (187/203). Multivariable logistic regression indicated that age [odds ratio (OR) = 1.68, 95% confidence interval (CI) 1.43–1.98; P < 0.001], gender (OR = 1.71, 95% CI 1.26–2.32; P = 0.001), surgical experience (OR = 2.07, 95% CI 1.56–2.75; P < 0.001), type of surgery (OR = 0.31, 95% CI 0.20–0.49; P < 0.001) and operative periods (OR = 2.69, 95% CI 1.61–4.86; P < 0.001) were independent predictors for intraoperative complications. The incidence of intraoperative complications during night-time surgery was significantly higher than that during daytime working hours. A 1:4 propensity score matching-based results verification showed that night-time surgery was still an independent risk factor after propensity score matching (OR = 2.76, 95% CI 1.47–5.15; P = 0.002). CONCLUSIONS The incidence of intraoperative complications from VATS pulmonary resection performed during night hours was significantly higher than that performed during working hours. In the present labour environment, thoracic surgeons should avoid night-time surgery whenever possible.

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