SAN FRANCISCO – Successful outcomes in 74 of 79 patients who underwent robotic-assisted thymectomy suggest that the technology is safe and feasible, results of a multicenter European study demonstrate.
Dr. Franca Melfi, of the University of Pisa in Italy, and her colleagues studied 79 patients with early thymoma who were surgically treated at multiple centers in Europe between 2002 and 2011. More than half, 45 patients, had myasthenia gravis. The mean operating time was 155 minutes. At last follow-up, 74 patients were still alive and free from recurrence. One patient died of a diffuse intrathoracic recurrence and the others died of causes unrelated to thymoma, Dr. Melfi said at the annual meeting of the American Association for Thoracic Surgery.
Improved depth perception and precise movements facilitated by articulated instruments are among the benefits of the robotic approach. The robot facilitates safe access to the thymus in the upper mediastinal area where the space is small and there are numerous vessels. This approach also allows a prolonged thymectomy when removal of all the fat is required, she explained.
The 608 reported robotic-assisted thymectomies worldwide come from 43 papers published since 2003, but most feature a small number of patients and/or a short follow-up, Dr. Melfi said. One of the few larger studies of robotic-assisted thymectomy included 106 patients with myasthenia gravis (Ann. N.Y. Acad. Sci. 2008:1132:329-35). Researchers in this prospective study reported a mean operative time of 186 minutes, a 1% conversion rate, and a 30-day mortality of 0%. They had a low overall postoperative morbidity rate (2 of 95 patients): one instance of bleeding and one nerve injury.
A greater than 40% complete and stable remission rate for myasthenia gravis was "a real interesting result," Dr. Melfi said, noting that the mean follow-up was 20 months. Most participants reported improved quality of life, she added.
Additional clinical experience and refinements to robotic-assisted thymectomy are warranted, Dr. Melfi said, acknowledging the need for prospective, randomized trials.
Dr. Melfi said she had no relevant financial disclosures.