Abstract

Background: Large thymomas present technical challenges, and open thymectomy has historically been favored to ensure safe resection and adequate oncologic clearance. However, minimally invasive surgery (MIS), including video-assisted and robotic approaches, is increasingly used. This systematic review and meta-analysis compared perioperative safety and oncologic outcomes between MIS and open thymectomy for large thymomas.
Methodology: A systematic search of PubMed, Scopus, Embase, the Cochrane Library, and Web of Science was performed from inception to November 2025. Comparative cohort studies evaluating MIS versus open thymectomy for large thymomas were included. Outcomes of interest included postoperative complications, pulmonary complications, margin status, R0 resection, extended resection, short-term mortality, blood loss, operative time, chest tube duration, and hospital length of stay. Random-effects meta-analyses were conducted in RevMan 5.4.3 using Mantel–Haenszel methods for odds ratios (ORs) and inverse-variance methods for mean differences (MDs), each with 95% confidence intervals (CIs).
Results: Four retrospective studies met inclusion criteria, comprising 799 patients (400 MIS; 399 open). MIS was associated with significantly lower odds of any postoperative complications compared with open thymectomy (OR = 0.23, 95% CI 0.11–0.50), while pulmonary complications were similar between groups (OR = 0.40, 95% CI 0.07–2.09). Oncologic endpoints did not differ significantly, including positive margins (OR = 1.27, 95% CI 0.89–1.81) and R0 resection (OR = 1.55, 95% CI 0.27–8.86). MIS reduced operative blood loss (MD = −149.37 mL, 95% CI −201.23 to −97.51) but required longer operative time (MD = +23.62 minutes, 95% CI 8.08–39.15). No clear differences were observed for chest tube duration, length of stay, extended resection, or 90-day mortality.
Conclusion: In available observational evidence, MIS for large thymomas appears to reduce overall postoperative complications and blood loss without compromising short-term oncologic outcomes, though operative time may be longer. Further prospective, standardized studies are warranted.

Key words: thymoma; thymectomy; minimally invasive surgery; robotic surgery; postoperative complications.