A comparison of robot-assisted thoracic surgery and median sternotomy for the treatment of early-stage thymoma: a propensity score matching study

For early-stage thymoma, Robot-assisted approaches for early-stage thymomas have become widespread. This study aimed to compare the surgical and survival outcomes of median sternotomy and robot-assisted thoracic surgery in patients with early-stage thymoma. Between 2010 and 2024, 203 patients with Masaoka stage I or II thymoma underwent either robot-assisted thoracic surgery (n = 68) or median sternotomy (n = 135). The clinical characteristics, surgical findings, and postoperative outcomes of the two approaches were compared. Propensity score matching was performed to manage selection bias. The baseline characteristics, including age, sex, smoking history, presence of myasthenia gravis, pulmonary function, clinical staging, and histological classification were not significantly different. Patients in the robot-assisted thoracic surgery group showed significantly lower fluorodeoxyglucose uptake on positron emission tomography and a smaller preoperative tumor size on computed tomography (P < 0.01). Intraoperative blood loss, drainage duration, postoperative hospital stay, and pathological tumor size were significantly lower in the robot-assisted thoracic surgery group (P < 0.01). In addition, this group had a significantly higher proportion of cases of early pathological Masaoka stage disease (P < 0.01). Overall survival and recurrence-free survival were comparable between the two groups. After propensity score matching, the 56 matched patient pairs demonstrated similar perioperative outcomes, overall survival, and recurrence-free survival. Robot-assisted thoracoscopic surgery was associated with significantly less intraoperative blood loss, shorter duration of chest drain placement, and shorter postoperative hospital stays than median sternotomy. Robot-assisted thoracoscopic surgery may be considered an effective, minimally invasive approach for early-stage thymoma without impairing survival outcomes.