The surgical approach strategies in the treatment of anterior mediastinal tumors

BACKGROUND: Anterior mediastinal tumors, involving structures such as the thymus and lymph nodes, pose significant clinical challenges due to their asymptomatic nature and potential to cause severe symptoms as they grow or invade surrounding organs. Treatment varies by tumor type, with surgery being crucial, especially for benign tumors and thymomas. The complex anatomy of the anterior mediastinum makes surgical approach selection critical for treatment outcomes. METHOD: A comprehensive literature search was conducted to identify studies related to surgical approaches for anterior mediastinal tumors. Two major databases, PubMed and Web of Science, were searched for studies published between 2000 and 2025. Key search terms included 'anterior mediastinal tumors', 'thymoma', 'Robot-Assisted Surgery', 'Video-Assisted Thoracoscopic Surgery (VATS)', and 'surgical approach'. Inclusion criteria were limited to clinical studies, reviews, and case series reporting on the surgical management of anterior mediastinal tumors in adults. Studies focusing on non-surgical treatment or lacking sufficient clinical outcome data were excluded. Due to wide variations in study designs, patient populations, and surgical techniques, a formal meta-analysis was not performed. Instead, a narrative review of the available literature was conducted to provide a comprehensive qualitative summary of current surgical strategies, their indications, and outcomes. This study explores various surgical approaches for anterior mediastinal tumors, including traditional open methods (e.g. Median Sternotomy) and minimally invasive techniques (e.g. Thoracoscopic and Robot-Assisted Surgery). It analyzes their indications, operative difficulty, complication rates, and postoperative recovery, integrating the latest technological advancements. RESULTS: Different surgical approaches have distinct characteristics. Traditional open surgeries offer clear exposure but result in significant trauma and complications. Minimally invasive techniques, such as Thoracoscopic Surgery, provide advantages like smaller incisions, reduced recovery time, and fewer complications, but require advanced technical skills and may have limited applicability for certain tumor locations and sizes. Robot-Assisted Surgery combines minimally invasive benefits with high precision and better visualization, though its high cost limits widespread use. CONCLUSION: The choice of a surgical approach should be personalized based on the tumor's location and size, the patient's clinical condition, and expected postoperative outcomes. For small, accessible tumors, Thoracoscopic Surgery is preferred; for complex or larger tumors, open or Robot-Assisted Surgery may be more suitable. Future advancements in technology and multidisciplinary collaboration are expected to further improve treatment outcomes for anterior mediastinal tumors.