Analysis of Patients Resected for Primary Mediastinal Mass: Which Surgical Approach is Superior

Abstract

Introduction: In recent years, robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) has been more frequently preferred in the surgical treatment of mediastinal masses. The number of studies comparing VATS with RATS is limited. In our study comparing the surgical outcomes of RATS and VATS procedures, we tried to determine the ideal treatment method. Methods: Between 2016 and 2022, fifty-two patients who underwent minimally invasive surgical resection (VATS or RATS) for mediastinal mass were retrospectively analyzed. Results: Mediastinal mass resection was performed by RATS (n=29) or VATS (n=23). 57.7% (n=30) of the mediastial masses were localized in the anterior mediastinum. The most common postoperative pathology was thymoma (27%, n=14). There was no surgical mortality. Grade 1 and 2 complications developed in 6 (11.5%) patients according to the Clavien-Dindo classification. Conversion to open surgery was required in a total of 5 patients [VATS group (n=3), 13% versus RATS group (n=2), 6.9%, p=0.644]. The median length of hospital stay was five days [VATS; 4 days interquartile range (IQR): 3-6] versus RATS; 5.5 days (IQR: 4-8), p=0.081]. The median drainage time was four days [VATS; 3 (2-5) versus RATS; 4.5 (3-7), p=0.133], and the mean drainage amount was 110 mL (70-190) (p=0.162). There was no significant difference between the duration of the operation ( for VATS; 75.7 +/- 18.4 min, for RATS; 73.5 +/- 18.0 min, p=0.674). Postoperative pain scores were similar [median 2.19 (1-3) for RATS and 2.20 (1-3) for VATS, p=1.00]. Conclusion: RATS and VATS are reliable procedures offering many advantages in treating mediastinal masses. Both procedures have similar results in terms of the complication rate, the length of the hospital stay, and duration of surgery.