Comparison of three methods in the surgical treatment of mediastinal roof tumors

Background: Robotic-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) are new modes for the surgical treatment of mediastinal tumors. The differences in perioperative efficacy and safety among RATS, VATS, and conventional open surgery (COS) are a major concern for surgeons. Most of the previous studies have not paid sufficient attention to mediastinal roof tumors. This study comprehensively analyzed the efficacy and safety of RATS, VATS, and COS for the surgical treatment of mediastinal roof tumors.

Methods: Patients who underwent resection of mediastinal roof tumors at our center from 2013 to 2023 were selected as the study cohort. Their perioperative and postoperative indexes were collected and cases were stratified according to tumor location for stratified analysis. The efficacy and safety of the three surgical methods were compared.

Results: A total of 213 patients were enrolled in this study: 57 RATS (26.8%), 115 VATS (54.0%), and 41 COS (19.2%). RATS and VATS were shown to be superior to COS in intraoperative bleeding, thoracic drainage time, and postoperative hospital stay. RATS and VATS had similar advantages over COS in the treatment of anterior region tumors. RATS could shorten the postoperative hospital stay and reduce the incidence of postoperative composite adverse outcomes for posterior region tumors. When the maximum tumor diameter was ≥30 mm, the RATS group had obvious advantages.

Conclusions: Our study suggests that RATS and VATS are safe and feasible for the resection of mediastinal roof tumors. VATS may be more appropriate for anterior region tumors, and RATS has advantages for posterior region tumors and large tumors.