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Clinical Outcomes and Technical Approach of Thymectomy in the Veterans Health Administration.

MedStar author(s):

Citation: Annals of Thoracic Surgery. 113(5):1648-1655, 2022 May.PMID: 34087238Institution: MedStar Washington Hospital CenterDepartment: MedStar General Surgery ResidencyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Thymectomy | *Thymus Neoplasms | Humans | Retrospective Studies | Thoracic Surgery, Video-Assisted/mt [Methods] | Thymectomy/mt [Methods] | Thymus Neoplasms/su [Surgery] | Treatment Outcome | Veterans HealthYear: 2022 Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:

0003-4975

Name of journal: The Annals of thoracic surgeryAbstract: BACKGROUND: Thymectomy is traditionally performed via transsternal incision, but less invasive modalities have emerged, including transcervical, thoracoscopic, and robotic approaches. Despite the advantages of video-assisted thoracoscopic surgery(VATS) over thoracotomy, most thymectomies are performed via sternotomy. This study compared the utilization and 30-day post-operative outcomes of transsternal, transcervical, and VATS thymectomy in the Veterans Health Administration.CONCLUSIONS: Transsternal approach comprised most thymectomy cases amongst veterans, while VATS thymectomy utilization increased over time and was associated with favorable outcomes. 30-day outcomes after thymectomy improved over time, which may reflect a trend towards wider utilization of less invasive approaches. Future studies should examine long-term outcomes. Copyright (c) 2021. Published by Elsevier Inc.METHODS: This was a retrospective review of veterans that underwent thymectomy via the Veterans Affairs Surgical Quality Improvement Program. 30-day outcomes were compared between techniques, adjusting for confounding covariates. Temporal trends were analyzed using Spearman's rank correlation coefficient, rho(rho).RESULTS: From 2008-2019, 594 thymectomies were performed: 376(63.3%) transsternal, 113(19.0%) VATS(including robotic approaches), and 105(17.7%) transcervical cases. VATS utilization increased from 0% in 2008 to 61% of case volume in 2019. Relative to transsternal technique, VATS thymectomy was associated with decreased odds of pulmonary complications (adjusted odds ratio=0.06;p=0.028) and shorter hospital stay (2.9+/-0.4 days shorter;p<0.001). No difference in outcomes was detected between VATS and transcervical thymectomy. Post-operative complication rate decreased from 17.7% in 2008 to 5.6% in 2019 (rho=-0.101;p=0.014). Length of stay decreased from median 4 days in 2008 to 3 days in 2019 (rho=-0.093;p=0.026). In thymic cancer, VATS 5-year overall survival was non-inferior to transsternal approach(71.3% vs. 74.6%; p=0.54).All authors: Antevil JL, Crowder HR, Holleran TJ, Napolitano MA, Sparks AD, Trachiotis GDOriginally published: Annals of Thoracic Surgery. 2021 Jun 01Fiscal year: FY2021 Digital Object Identifier:

https://dx.doi.org/10.1016/j.athoracsur.2021.05.020

Date added to catalog: 2021-07-19

Holdings ( 1 )
Title notes ( 6 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	34087238	Available		34087238

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

BACKGROUND: Thymectomy is traditionally performed via transsternal incision, but less invasive modalities have emerged, including transcervical, thoracoscopic, and robotic approaches. Despite the advantages of video-assisted thoracoscopic surgery(VATS) over thoracotomy, most thymectomies are performed via sternotomy. This study compared the utilization and 30-day post-operative outcomes of transsternal, transcervical, and VATS thymectomy in the Veterans Health Administration.

CONCLUSIONS: Transsternal approach comprised most thymectomy cases amongst veterans, while VATS thymectomy utilization increased over time and was associated with favorable outcomes. 30-day outcomes after thymectomy improved over time, which may reflect a trend towards wider utilization of less invasive approaches. Future studies should examine long-term outcomes. Copyright (c) 2021. Published by Elsevier Inc.

METHODS: This was a retrospective review of veterans that underwent thymectomy via the Veterans Affairs Surgical Quality Improvement Program. 30-day outcomes were compared between techniques, adjusting for confounding covariates. Temporal trends were analyzed using Spearman's rank correlation coefficient, rho(rho).

RESULTS: From 2008-2019, 594 thymectomies were performed: 376(63.3%) transsternal, 113(19.0%) VATS(including robotic approaches), and 105(17.7%) transcervical cases. VATS utilization increased from 0% in 2008 to 61% of case volume in 2019. Relative to transsternal technique, VATS thymectomy was associated with decreased odds of pulmonary complications (adjusted odds ratio=0.06;p=0.028) and shorter hospital stay (2.9+/-0.4 days shorter;p<0.001). No difference in outcomes was detected between VATS and transcervical thymectomy. Post-operative complication rate decreased from 17.7% in 2008 to 5.6% in 2019 (rho=-0.101;p=0.014). Length of stay decreased from median 4 days in 2008 to 3 days in 2019 (rho=-0.093;p=0.026). In thymic cancer, VATS 5-year overall survival was non-inferior to transsternal approach(71.3% vs. 74.6%; p=0.54).

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