Comparison of postoperative outcomes between two surgical approaches in patients with early-stage non-myasthenic thymoma: a systematic review and meta-analysis

Thymoma is one of the most common tumors of the anterior mediastinum, and surgical resection remains the primary treatment. Extended thymectomy (ET) is generally recommended for patients with myasthenia gravis (MG); however, its necessity in patients with early-stage non-MG thymoma remains controversial. To systematically evaluate the differences in perioperative and long-term outcomes between ET and simple thymoma resection (ST) in patients with early-stage non-MG thymoma, and to provide evidence for surgical decision-making. A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, and CNKI databases from inception to July 30, 2026. The quality of non-randomized studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Odds ratios (ORs) were used for dichotomous variables, mean differences (MDs) for continuous variables, and hazard ratios (HRs) for survival outcomes. A random-effects model was applied when heterogeneity was significant (I² > 50%); otherwise, a fixed-effects model was used. A total of 14 studies involving 3,559 patients were included. Compared with the ST group, the ET group had a longer operative time ( P = 0.0002), greater intraoperative blood loss ( P = 0.003), longer postoperative drainage duration ( P = 0.0004), and longer hospital stay ( P = 0.007), as well as a higher incidence of overall postoperative complications ( P = 0.001). In addition, the ET group showed a higher rate of distant recurrence ( P = 0.02). No significant differences were observed in other outcomes, including tumor size, proportion of stage I–II patients, postoperative MG incidence, cardiac complications, R0 resection rate, overall and subtype recurrence, adjuvant therapy rate, thymoma-related mortality, 30-day mortality, overall survival, and recurrence-free survival. For patients with early-stage non-MG thymoma, ET is associated with inferior perioperative outcomes compared with ST and does not demonstrate a clear long-term survival benefit. Current evidence suggests that ST may be a preferable surgical option in carefully selected patients; however, further high-quality studies are needed for confirmation.