Perioperative safety and efficacy of minimally invasive vs. open thymectomy for large thymomas: a systematic review and meta-analysis.

This study aims to systematically examine how minimally invasive thymectomy-covering both video-assisted and robotic-assisted methods-compares with open thymectomy in terms of perioperative safety and effectiveness for treating large thymomas. We thoroughly searched several databases for relevant studies, including randomized controlled trials and cohort studies, published up until October 2025. Data on perioperative factors, including surgical duration, blood loss, length of hospitalization, complications, and recurrence rates, were extracted and analyzed using random-effects models in STATA 18. Seven studies involving 12,880 patients were included. open surgery showed significantly more blood loss (WMD = 110.43, 95% CI 105.83-115.03; P < 0.05), longer hospital stays (WMD = 2.04, 95% CI 1.38-2.7; P < 0.05) compared to MIT. No notable difference in surgical duration was observed. Moreover, minimally invasive thymectomy (MIT) was associated with a reduced rate of recurrence after surgery (OR = 0.54, 95% CI 0.35-0.84; P < 0.05) as well as fewer postoperative complications (OR = 0.27, 95% CI 0.19-0.39; P < 0.05). MIT offers significant advantages over open surgery for large thymomas, including reduced blood loss, shorter hospital stays, and lower rates of complications and recurrence, though operative time was similar. Further large-scale studies are needed to confirm these findings and assess long-term efficacy.