ArticleEuropean journal of medical research2025
Comparison of subxiphoid vs intercostal VATS approaches for anterior mediastinal tumors: a retrospective cohort study with focus on elderly patients.
Article in European journal of medical research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe best minimally invasive approach for anterior mediastinal tumors in geriatric patients is unknown. The objective of this study was to evaluate clinical outcomes of video-assisted thoracic surgery (VATS) using subxiphoid (S-VATS) and lateral intercostal (I-VATS) approaches with specific emphasis on perioperative safety and early postoperative recovery in geriatric patients.
methodsA total of 293 VATS resections of anteromedial mediastinal tumors were performed from June 2017 to June 2022; of these, 48 patients were classified as elderly (≥ 65 years). A propensity score matching analysis was performed to balance baseline covariates to compare outcomes between S-VATS (n = 15) and I-VATS (n = 33) patients, as well as additional comparisons to younger cohorts.
resultsElderly patients had significantly more comorbidities than younger patients (58.3% vs 32.7%, p = 0.001). The S-VATS approach in elderly patients resulted in decreased early postoperative pain as compared to the I-VATS approach (24-h VAS-2.53 ± 0.63 vs 3.63 ± 1.04, p = 0.017). Operative time, intraoperative blood loss, and postoperative complication rate were similar across both groups, suggesting that both approaches were equally safe.
conclusionBoth S-VATS and I-VATS for anterior mediastinal tumor resection are safe and feasible in geriatric patients. The S-VATS approach may have the advantage of better early postoperative pain control, although this must be interpreted with caution due to the small sample size and evaluation of pain at a single postoperative point. Further studies are warranted to validate these findings, including larger prospective studies.
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