Should minimally invasive surgery be the standard approach for early-stage thymoma? A 20-year experience

Background: Minimally invasive surgery (MIS) has become the prevailing technique for resecting early-stage thymoma; however, studies evaluating the oncologic impact of this evolution are lacking. This study aimed to characterize the transition from open surgery to MIS and to evaluate outcomes. Methods: This was a retrospective, single-institution review of resections performed for pathologic TNM stage I-II thymomas between January 2000 and September 2023. The relationships between factors and recurrence were quantified using competing risk regression before and after applying overlap propensity score weights. Overlap propensity score weighting revealed a cumulative incidence of recurrence at 5 years of 5.1% (95% confidence interval [CI], 0.97%-9.2%) for open surgery (n = 47) compared to 7.1% (95% CI, 2.0%-12.9%) for MIS (n = 47), a non-statistically significant difference. Conclusions: MIS has become the principal approach for resecting early-stage thymoma over the last 2 decades. MIS is associated with a lower complication rate and shorter LOS but may be associated with a higher risk of recurrence in certain situations. Larger studies to evaluate the appropriate role of MIS are warranted.