Recurrence and Survival Following Robotic Resection of Thymomas Greater Than Five Centimeters

BACKGROUND AND METHODS: Minimally invasive large thymoma resection remains controversial given the paucity of long-term oncological outcomes. We described the recurrence and survival of patients with thymomas ≥ 5 cm resected robotically. METHODS: Consecutive thymoma resections between January 2006 and December 2022 were reviewed. Thymic carcinoma/neuroendocrine tumors, induction therapy treatment, and Stage IV disease were excluded. For thymomas ≥ 5 cm, open versus robotic resections were compared. With robotic resections, thymomas ≥/< 5 cm were compared. The outcomes were freedom from recurrence (FFR) and overall survival (OS). RESULTS: There were 40 thymomas ≥ 5 cm (15 open and 25 robotic) and 52 robotic thymoma < 5 cm resections. Median follow-up was 5 years with 4 (4%) patients having recurrences and 5 (5%) demised. In thymomas ≥ 5 cm, patients were similar, except for higher comorbidities in the open cohort. Five-year FFR (p = 0.42) and OS (p = 0.34) were comparable. Patients with robotic resection of thymomas ≥/< 5 cm were similar, except those < 5 cm were more frequently Masaoka-Koga Stage II. Five-year FFR (p = 0.62) and OS (p = 0.62) were similar. CONCLUSIONS: Resectable large thymomas, ≥ 5 cm, can be approached robotically with similar recurrence and survival when compared to open or smaller robotic resections. In otherwise appropriate thymomas, considerations such as location and proximity to surrounding structures, over size alone, should guide the approach.