Perioperative efficacy of subxiphoid and intercostal thoracoscopic thymectomy: a systematic review and meta-analysis

To assess the efficacy and safety of subxiphoid thoracoscopic thymectomy (SVATS) for thymoma using meta-analysis and to compare it with intercostal thoracoscopic thymectomy (IVATS). Electronic databases (PubMed, Web of Science, Cochrane Library and Embase) were systematically searched for original studies comparing SVATS and IVATS. A random-effects model was used to evaluate differences in operative time, intraoperative blood loss, postoperative drainage duration, postoperative hospital stay, visual analogue scale (VAS) score and postoperative complications between the two approaches. A total of 14 cohort studies, comprising 1,647 patients, met the inclusion criteria. The results indicated that the SVATS group had significantly lower intraoperative blood loss (mean differences MD: −14.65 ml; 95% confidence intervals CI: −22.17 to − 7.1), postoperative drainage volume (MD: −66.14 ml; 95% CI: −131.02 to − 1.26), postoperative drainage duration (MD: −0.73 days; 95% CI: −1.36 to − 0.11), postoperative pain score (standardised mean differences SMD: −1.86; 95% CI: −2.37 to − 1.35) and hospital stay (MD: −1.20 days; 95% CI: −1.62 to − 0.78) compared with the control group. There was no significant difference in operative time (MD: −10.36 min; 95% CI: −25.57 to 4.85) or total postoperative complications between the two groups. The SVATS method is effective and safe, with superior perioperative outcomes compared with IVATS. However, high-quality prospective studies are still needed to further validate these findings.