Perioperative Efficacy and Survival Prognosis of Subxiphoid Versus Intercostal Thoracoscopic Surgery for Large-Sized Thymoma: A Multicenter Retrospective Study

Background Anterior mediastinal tumors, including thymoma, teratoma, lipoma, and pericardial cyst, represent the most common subtype of mediastinal tumors, among which thymoma is the most prevalent malignant tumor in the anterior mediastinum. With the widespread application of high-resolution spiral computed tomography (HRCT) and the intensification of health screening, the detection rate of thymoma has been significantly improved. Surgical resection remains the cornerstone of treatment, with intercostal video-assisted thoracoscopic surgery (IVATS) serving as the mainstream approach. In recent years, under the principles of enhanced recovery after surgery (ERAS), the subxiphoid VATS (SVATS) approach has attracted considerable attention. Nevertheless, robust evidence-based data comparing its perioperative efficacy and postoperative survival outcomes with the traditional intercostal approach for anterior mediastinal tumor resection remains lacking. Methods This retrospective study included 138 patients with thymomas (5.0–10.0 cm) who underwent subxiphoid or intercostal VATS at two hospitals from January 2018 to January 2023. Clinical data, intraoperative and postoperative outcomes, complications and overall survival were analyzed. The primary endpoints included overall survival (OS), intraoperative blood loss, and duration of postoperative oral analgesic use. The secondary endpoints comprised postoperative drainage volume, operative time, postoperative length of hospital stay, and postoperative complications. Results After matching, 138 patients were analyzed, drainage volume (subxiphoid: 437.09 ± 410.75 mL, intercostal: 662.71 ± 690.83 mL, P = 0.017), and duration of postoperative analgesic use (subxiphoid: 2.11 ± 1.27 days, intercostal: 3.88 ± 1.04 days, P < 0.001). Overall survival were prestened (HR for death, 0.3 95% CI, 0.06 to 2.20; P = 0.25). Conclusion Compared with IVATS, SVATS for large thymomas is associated with less postoperative drainage volume and shorter duration of oral analgesic use, demonstrating advantages in short-term perioperative efficacy.