Perioperative outcomes comparisons of thymoma treatment between robot-assisted thymectomy (RATS) and video-assisted thymectomy (VATS): a meta-analysis

AIM: To conduct a meta-analysis to determine the relative merits between robot-assisted thymectomy (RATS) and video-assisted thymectomy (VATS) for thymoma treatment. METHODS: A total of 1860 patients who underwent thymectomy were included in this study. Of these, 897 patients underwent RATS and 963 underwent VATS. Perioperativeive outcomes were compared. Pooled odds ratio (OR) and standardized mean differences (SMDs) with 95% confidence intervals (95% CIs) were calculated using either the fixed effects model or the random effects model. RESULTS: 15 studies were included with a total of 1860 patients, including 897 patients in the RATS group and 963 patients in the VATS group. Compared to VATS, reports of RATS indicated favorable outcomes considering the hospital stay (SMD = -1.52, 95% CI -2.39 to -0.65), estimated blood loss (SMD = -27.42, 95% CI -50.51 to -4.34), duration of chest tube insertion (SMD = -1.07, 95% CI -1.81 to -0.32), volume of drainage (SMD = -61.55, 95% CI -166.97 to 43.87), conversion to open (OR = 0.32, 95% CI 0.18 to 0.56). Operative time and ICU stay with RATS were not significantly different from VATS (SMD = 1.62; 95% CI -11.79 to 15.03; P = 0.81), (SMD = -0.13; 95% CI -0.32 to 0.06; P = 0.17). The mortality and complications rates in both groups were comparable (OR 0.64, 95% CI 0.20–2.10; P = 0.46), (OR 0.89, 95% CI 0.54–1.48; P = 0.66). Meanwhile, the sub-group meta-analysis for hospital stay indicated that RATS yielded a shorter time compared with VATS in non-Asian patients with no significant difference(SMD = 1.62, 95% CI -11.79 to 15.03, P = 0.81). The meta-analysis for complications indicated no difference in sub-group. (OR = 0.89, 95% CI -0.54 to 1.48, P = 0.66). CONCLUSION: Our study suggests that the RATS approach is a feasible alternative approach and even a better option for thymoma surgery treatment. Further studies are required to confirm these results.