Thymic Carcinoma Resected via a Subxiphoid Uniportal Approach

Background: Thymic carcinomas are rare tumors that are rarely diagnosed pathologically following surgical resection.Recently, subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) have been reported as lesser invasive approaches for anterior mediastinal tumors.In cases where thymic carcinoma is diagnosed intraoperatively, the possibility of transitioning from VATS to median sternotomy for extended thymectomy is currently under discussion.In this review, we present the cases of thymic carcinoma and discuss appropriate management strategies.Methods: Thymic carcinoma cases surgically resected via the subxiphoid approach at our institution from August 2018 to December 2024 were retrospectively reviewed.We confirmed patients to be free of metastasis, as verified by positron emission tomography (PET) scans.In both VATS and RATS, a single 3-4 cm longitudinal skin incision was made beneath the xiphoid process, and a wound protector was employed to ensure a proper seal and facilitate CO2 insufflation.A 30 angled endoscope was utilized during the procedure.In RATS, 3 robotic arms were inserted through the uniport.In this presentation, we will outline our surgical techniques.Results: Five patients were included in the study.The patient characteristics were as follows: 4 males and 1 female, mean age of 67 years and a mean tumor size of 22 mm.The surgical approaches were 4 VATSs and 1 RATS.According to the World Health Organization pathological staging, 3 cases were classified as stage I, and 2 cases were classified as stage IIIa, involving the lung and left innominate vein.One patient exhibited relapse of the inferior mediastinal and subaortic lymph nodes 17 months after surgery, whereas 4 cases did not exhibit any obvious recurrence.Conclusion: Subxiphoid uniportal VATS and RATS are lesser invasive approaches that are technically feasible.In 1 case, recurrence was noted at the subaortic lymph node, which was outside the area of the extended thymectomy.When a PET scan shows no metastasis following complete resection of thymic carcinoma, the significance of an additional extended thymectomy remains unclear.