328P Trimodality therapy in malignant pleural mesothelioma: Does radiation truly improve survival? A SEER database analysis

Background: Anterior mediastinal tumors, including thymoma, teratoma, lipoma, and pericardial cysts, represent the most prevalent subtype of mediastinal tumors.With the widespread use of high-resolution spiral CT and enhanced health screening, the detection rate of these tumors has significantly increased.Surgical resection remains the cornerstone of treatment, with intercostal video-assisted thoracoscopic surgery (VATS) being the mainstream approach.In recent years, the subxiphoid VATS approach has gained traction under the principles of enhanced recovery after surgery (ERAS).However, there is a paucity of robust evidence-based data comparing its perioperative efficacy to the traditional intercostal approach for anterior mediastinal tumor resection.Methods: This retrospective study included 247 patients with large anterior mediastinal tumors (5.0-10.0cm) who underwent subxiphoid or intercostal VATS at two hospitals (Sir Run Run Shaw Hospital and the First Affiliated Hospital, Zhejiang University School of Medicine) from January 2018 to January 2023.Clinical data, intraoperative and postoperative outcomes, and complications were analyzed.Primary endpoints were blood loss and postoperative analgesic duration; secondary endpoints included operative time, hospital stay, and complications.A 1:1 propensity score matching was performed to balance confounders.Results: After matching, 132 patients (66 pairs) were analyzed.Postoperative analgesic duration was shorter in the subxiphoid group (2.01 1.85 days) vs. intercostal group (2.59 1.53 days, P=0.035), showing statistical significance.Conclusions: Subxiphoid VATS is effective, minimally invasive, and safe for large anterior mediastinal tumors, with less postoperative pain than intercostal VATS.However, further studies are needed due to the small sample size.