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Background <p>The best minimally invasive approach for anterior mediastinal tumors in geriatric patients is unknown. The objective of this study was to evaluate clinical outcomes of video-assisted thoracic surgery (VATS) using subxiphoid (S-VATS) and lateral intercostal (I-VATS) approaches with specific emphasis on perioperative safety and early postoperative recovery in geriatric patients.</p> Methods <p>A total of 293 VATS resections of anteromedial mediastinal tumors were performed from June 2017 to June 2022; of these, 48 patients were classified as elderly (≥ 65&#xa0;years). A propensity score matching analysis was performed to balance baseline covariates to compare outcomes between S-VATS (<i>n</i> = 15) and I-VATS (<i>n</i> = 33) patients, as well as additional comparisons to younger cohorts.</p> Results <p>Elderly patients had significantly more comorbidities than younger patients (58.3% vs 32.7%, <i>p</i> = 0.001). The S-VATS approach in elderly patients resulted in decreased early postoperative pain as compared to the I-VATS approach (24-h VAS-2.53 ± 0.63 vs 3.63 ± 1.04, <i>p</i> = 0.017). Operative time, intraoperative blood loss, and postoperative complication rate were similar across both groups, suggesting that both approaches were equally safe.</p> Conclusion <p>Both S-VATS and I-VATS for anterior mediastinal tumor resection are safe and feasible in geriatric patients. The S-VATS approach may have the advantage of better early postoperative pain control, although this must be interpreted with caution due to the small sample size and evaluation of pain at a single postoperative point. Further studies are warranted to validate these findings, including larger prospective studies.</p>

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Comparison of subxiphoid vs intercostal VATS approaches for anterior mediastinal tumors: a retrospective cohort study with focus on elderly patients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月24日

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  • Huiming Xu,
  • Yihua Lai,
  • Guilong Li,
  • Wenshan Zhang,
  • Rongqiang Shen,
  • Yi Zhang

摘要

Background

The best minimally invasive approach for anterior mediastinal tumors in geriatric patients is unknown. The objective of this study was to evaluate clinical outcomes of video-assisted thoracic surgery (VATS) using subxiphoid (S-VATS) and lateral intercostal (I-VATS) approaches with specific emphasis on perioperative safety and early postoperative recovery in geriatric patients.

Methods

A total of 293 VATS resections of anteromedial mediastinal tumors were performed from June 2017 to June 2022; of these, 48 patients were classified as elderly (≥ 65 years). A propensity score matching analysis was performed to balance baseline covariates to compare outcomes between S-VATS (n = 15) and I-VATS (n = 33) patients, as well as additional comparisons to younger cohorts.

Results

Elderly patients had significantly more comorbidities than younger patients (58.3% vs 32.7%, p = 0.001). The S-VATS approach in elderly patients resulted in decreased early postoperative pain as compared to the I-VATS approach (24-h VAS-2.53 ± 0.63 vs 3.63 ± 1.04, p = 0.017). Operative time, intraoperative blood loss, and postoperative complication rate were similar across both groups, suggesting that both approaches were equally safe.

Conclusion

Both S-VATS and I-VATS for anterior mediastinal tumor resection are safe and feasible in geriatric patients. The S-VATS approach may have the advantage of better early postoperative pain control, although this must be interpreted with caution due to the small sample size and evaluation of pain at a single postoperative point. Further studies are warranted to validate these findings, including larger prospective studies.