{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T04:49:41Z","timestamp":1782103781751,"version":"3.54.5"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Video-assisted thoracoscopic extended thymectomy (VATET) is widely used for thymoma. This study compared perioperative, neurological, and short-term oncologic outcomes between subxiphoid and lateral intercostal approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study included 168 patients who underwent VATET between January 2020 and May 2024. Patients were divided into the subxiphoid approach group (SA,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200985) and the lateral intercostal approach group (ICA,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200983). Outcomes included intraoperative blood loss, postoperative hospital stay, drainage duration, hospitalization costs, postoperative pain assessed by the visual analogue scale (VAS), complications graded using the Clavien\u2013Dindo classification, histopathological findings, neurological outcomes assessed using Myasthenia Gravis Foundation of America Post-Intervention Status (MGFA-PIS), and thymoma recurrence. Multivariable logistic regression identified factors associated with prolonged hospitalization.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline characteristics were comparable (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05), and histopathological features were similar between groups. Compared with the SA group, the ICA group had lower intraoperative blood loss, shorter postoperative stay, shorter drainage duration, and lower hospitalization costs (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). VAS scores on postoperative days 1, 3, and 7 were lower in the SA group (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Complication rates were comparable (8.24% vs. 6.02%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05). Neurological outcomes in myasthenia gravis were similar between groups. Thymoma recurrence occurred in two patients in each group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both approaches are safe and feasible for VATET. The lateral intercostal approach improves operative efficiency, whereas the subxiphoid approach reduces early postoperative pain without affecting neurological or short-term oncologic outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1802382","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T04:37:14Z","timestamp":1782103034000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of subxiphoid and lateral intercostal approaches for video-assisted thoracoscopic extended thymectomy: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Shuai","family":"Shi","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, The People's Hospital of Dazu","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenlin","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University","place":["Changsha, Hunan Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuxin","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University","place":["Changsha, Hunan Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junting","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University","place":["Changsha, Hunan Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhua","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University","place":["Changsha, Hunan Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"726","DOI":"10.3978\/j.issn.2072-1439.2014.04.08","article-title":"Comparative study of video-assisted thoracic surgery versus open thymectomy for thymoma in one single center","volume":"6","author":"Yuan","year":"2014","journal-title":"J Thorac Dis"},{"key":"B2","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1245\/s10434-013-3228-7","article-title":"Video-assisted thoracoscopic surgical thymectomy to treat early thymoma: a comparison with the conventional transsternal approach","volume":"21","author":"Liu","year":"2014","journal-title":"Ann Surg Oncol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e70094","DOI":"10.1111\/1759-7714.70094","article-title":"Expert consensus on subxiphoid and subcostal arch thoracoscopic resection for the treatment of thymoma","volume":"16","author":"Yin","year":"2025","journal-title":"Thorac Cancer"},{"key":"B4","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.jtho.2015.08.004","article-title":"Minimally invasive versus open thymectomy for thymic malignancies: systematic review and meta-analysis","volume":"11","author":"Friedant","year":"2016","journal-title":"J Thorac Oncol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1309173","DOI":"10.3389\/fneur.2024.1309173","article-title":"Are the minimally invasive techniques the new gold standard in thymus surgery for myasthenia gravis? 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