{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:16:40Z","timestamp":1790054200693,"version":"4.0.1"},"reference-count":31,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T00:00:00Z","timestamp":1705536000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Thymectomy is the gold standard in the treatment of thymic neoplasm and plays a key role in the therapeutic path of myasthenia gravis. For years, sternotomy has been the traditional approach for removing anterior mediastinal lesions, although the robotic thymectomy is now widely performed. The literature is still lacking in papers comparing the two approaches and evaluating long-term oncological and neurological outcomes. This study aims to analyze the postoperative results of open and robotic thymectomy for thymic neoplasms in myasthenic patients. Surgical, oncological and neurological data of myasthenic patients affected by thymic neoplasms and surgically treated with extended thymectomy, both with the open and the robotic approach, in six Italian Thoracic Centers between 2011 and 2021 were evaluated. A total of 213 patients were enrolled in the study: 110 (51.6%) were treated with the open approach, and 103 (48.4%) were treated with robotic surgery. The open surgery, compared with the robotic, presented a shorter operating time (p &lt; 0.001), a higher number of postoperative complications (p = 0.038) and longer postoperative hospitalization (p = 0.006). No other differences were observed in terms of surgical, oncological or neurological outcomes. The robotic approach can be considered safe and feasible, comparable to the open technique, in terms of surgical, oncological and neurological outcomes.<\/jats:p>","DOI":"10.3390\/cancers16020406","type":"journal-article","created":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T03:50:56Z","timestamp":1705549856000},"page":"406","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["National Multicenter Study on the Comparison of Robotic and Open Thymectomy for Thymic Neoplasms in Myasthenic Patients: Surgical, Neurological and Oncological Outcomes"],"prefix":"10.3390","volume":"16","author":[{"given":"Elisa","family":"Sicolo","sequence":"first","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery\u2014Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3240-9313","authenticated-orcid":false,"given":"Carmelina Cristina","family":"Zirafa","sequence":"additional","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery\u2014Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Romano","sequence":"additional","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery\u2014Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jury","family":"Brandolini","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3336-0021","authenticated-orcid":false,"given":"Angela","family":"De Palma","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari \u201cAldo Moro\u201d, 70121 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2722-9270","authenticated-orcid":false,"given":"Stefano","family":"Bongiolatti","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5579-0837","authenticated-orcid":false,"given":"Filippo Tommaso","family":"Gallina","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit IRCCS Regina Elena National Cancer Center, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4638-8528","authenticated-orcid":false,"given":"Sara","family":"Ricciardi","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0960-4938","authenticated-orcid":false,"given":"Michelangelo","family":"Maestri","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melania","family":"Guida","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7783-0262","authenticated-orcid":false,"given":"Riccardo","family":"Morganti","sequence":"additional","affiliation":[{"name":"Section of Statistics, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graziana","family":"Carleo","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari \u201cAldo Moro\u201d, 70121 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8358-9038","authenticated-orcid":false,"given":"Giovanni","family":"Mugnaini","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Taj\u00e8","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit IRCCS Regina Elena National Cancer Center, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizia","family":"Calabr\u00f3","sequence":"additional","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery\u2014Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Lenzini","sequence":"additional","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery\u2014Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Davini","sequence":"additional","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery\u2014Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6414-8475","authenticated-orcid":false,"given":"Giuseppe","family":"Cardillo","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7137-8946","authenticated-orcid":false,"given":"Francesco","family":"Facciolo","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit IRCCS Regina Elena National Cancer Center, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Voltolini","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Marulli","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari \u201cAldo Moro\u201d, 70121 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4890-2578","authenticated-orcid":false,"given":"Piergiorgio","family":"Solli","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1773-8269","authenticated-orcid":false,"given":"Franca","family":"Melfi","sequence":"additional","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery\u2014Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1093\/ejcts\/ezy075","article-title":"Comparing robotic and trans-sternal thymectomy for early-stage thymoma: A propensity score-matching study","volume":"54","author":"Marulli","year":"2018","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1093\/ejcts\/ezaa406","article-title":"Myasthenia is a poor prognostic factor for perioperative outcomes after robotic thymectomy for thymoma","volume":"59","author":"Kumar","year":"2021","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.thorsurg.2014.02.012","article-title":"Robotic thymectomy for myasthenia gravis","volume":"24","author":"Ismail","year":"2014","journal-title":"Thorac. Surg. Clin."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1056\/NEJMoa1602489","article-title":"Randomized Trial of Thymectomy in Myasthenia Gravis","volume":"375","author":"Wolfe","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1016\/j.athoracsur.2012.04.097","article-title":"Minimally invasive thymectomy and open thymectomy: Outcome analysis of 263 patients","volume":"94","author":"Jurado","year":"2012","journal-title":"Ann. Thorac. Surg."},{"key":"ref_6","first-page":"18","article-title":"Multi-institutional European experience of robotic thymectomy for thymoma","volume":"5","author":"Marulli","year":"2016","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1007\/s11701-018-0816-3","article-title":"Robotic-assisted thymectomy for early-stage thymoma: A propensity-score matched analysis","volume":"12","author":"Casiraghi","year":"2018","journal-title":"J. Robot. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1093\/ejcts\/ezab014","article-title":"Minimally invasive thymectomy for myasthenia gravis favours a left-sided approach and low severity class","volume":"60","author":"Wilshire","year":"2021","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/S0003-4975(96)00376-1","article-title":"Extended thymectomy for myasthenia gravis patients: A 20-year review","volume":"62","author":"Masaoka","year":"1996","journal-title":"Ann. Thorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1016\/j.athoracsur.2017.05.074","article-title":"Robotic Thymectomy Is Feasible for Large Thymomas: A Propensity-Matched Comparison","volume":"104","author":"Kneuertz","year":"2017","journal-title":"Ann. Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"v40","DOI":"10.1093\/annonc\/mdv277","article-title":"Thymic epithelial tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"26","author":"Girard","year":"2015","journal-title":"Ann. Oncol."},{"key":"ref_12","unstructured":"National Comprehensive Cancer Network (2022, December 15). NCCN Clinical Practice Guidelines in Oncology: Thymomas and Thymic Carcinomas; Version 1.2023. Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/thymic.pdf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/0003-4975(93)90942-B","article-title":"Thoracoscopy in the management of anterior mediastinal masses","volume":"56","author":"Sugarbaker","year":"1993","journal-title":"Ann. Thorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1093\/ejcts\/ezab253","article-title":"Robotic thymectomy for thymoma in patients with myasthenia gravis: Neurological and oncological outcomes","volume":"60","author":"Romano","year":"2021","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1212\/WNL.55.1.16","article-title":"Myasthenia gravis: Recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America","volume":"55","author":"Jaretzki","year":"2000","journal-title":"Neurology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/s00464-011-1879-7","article-title":"Robot-assisted thymectomy is superior to transsternal thymectomy","volume":"26","author":"Weksler","year":"2012","journal-title":"Surg. Endosc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1055\/s-0035-1549007","article-title":"Robotic-assisted thymectomy: Surgical procedure and results","volume":"63","author":"Rueckert","year":"2015","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1093\/ejcts\/ezu352","article-title":"Robotic thymectomy in patients with myasthenia gravies: Neurological and surgical outcomes","volume":"48","author":"Keijzers","year":"2015","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1080\/14737175.2019.1600404","article-title":"An update on thymectomy in myasthenia gravis","volume":"19","author":"Evoli","year":"2019","journal-title":"Expert. Rev. Neurother."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.thorsurg.2018.12.011","article-title":"History of Thymectomy for Myasthenia Gravis","volume":"29","author":"Cooper","year":"2019","journal-title":"Thorac. Surg. Clin."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.athoracsur.2008.11.040","article-title":"Comparative clinical outcomes of thymectomy for myasthenia gravis performed by extended transsternal and minimally invasive approaches","volume":"87","author":"Meyer","year":"2009","journal-title":"Ann. Thorac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.athoracsur.2011.04.043","article-title":"Thoracoscopic thymectomy for myasthenia gravis with and without thymoma: A single-centre experience","volume":"93","author":"Yu","year":"2012","journal-title":"Ann. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"48","DOI":"10.5152\/eurasianjmed.2017.17009","article-title":"Thymectomy in Myasthenia Gravis","volume":"49","author":"Aydin","year":"2017","journal-title":"Eurasian J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1067\/mtc.2001.115231","article-title":"Thoracoscopic thymomectomy with the da Vinci computer-enhanced surgical system","volume":"122","author":"Yoshino","year":"2001","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1016\/j.jtcvs.2012.07.082","article-title":"Robot-aided thoracoscopic thymectomy for early-stage thymoma: A multicenter European study","volume":"144","author":"Marulli","year":"2012","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.jtcvs.2019.11.114","article-title":"A national analysis of open versus minimally invasive thymectomy for stage I to III thymoma","volume":"160","author":"Yang","year":"2020","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e7161","DOI":"10.1097\/MD.0000000000007161","article-title":"Thymectomy via open surgery or robotic video assisted thoracic surgery: Can a recommendation already be made?","volume":"96","author":"Buentzel","year":"2017","journal-title":"Medicine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"174","DOI":"10.21037\/acs.2019.02.04","article-title":"A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy","volume":"8","author":"Kreaden","year":"2019","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3321","DOI":"10.1007\/s00464-022-09757-y","article-title":"The short and long-term effects of open vs minimally invasive thymectomy in myasthenia gravis patients: A systematic review and meta-analysis","volume":"37","author":"Lee","year":"2023","journal-title":"Surg. Endosc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"E639","DOI":"10.21037\/jtd.2018.07.103","article-title":"Chylothorax after thoracoscopic extended thymectomy: A case report and literatures review","volume":"10","author":"Zhang","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"6353","DOI":"10.21037\/jtd-20-2660","article-title":"Minimally invasive surgery in the management of resectable thymoma: A retrospective analysis from the National Cancer Database","volume":"13","author":"Salfity","year":"2021","journal-title":"J. Thorac. Dis."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/2\/406\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:49:16Z","timestamp":1760104156000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/2\/406"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,18]]},"references-count":31,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["cancers16020406"],"URL":"https:\/\/doi.org\/10.3390\/cancers16020406","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,18]]}}}