Anterior mediastinal tumor surgery applying single-port thoracoscopy using the subxiphoid approach

Background: This study aims to investigate the effectiveness of application of single-port thoracoscopy using the subxiphoid approach in anterior mediastinal tumor surgery.Methods: Between June 2014 and June 2016, a total of 108 patients (59 males, 49 females; mean age: 64.9 +/- 7.5 years; range, 45 to 79 years) with anterior mediastinal tumors were randomized into subxiphoid (experimental) or right chest (control) groups. Single-port thoracoscopy using the subxiphoid approach was performed in the subxiphoid group, while thoracoscopy using the right thoracic approach was performed in the control group. Pre - and postoperative pain stress indicators, Visual Analog Scale scores, quality of life scores, postoperative tumor recurrence, and five-year survival rates were compared between the groups.Results: There were no mortality or serious complications in either group. The mean Visual Analog Scale pain scores on postoperative Days 1 and 7 were 6.5 +/- 0.8 and 2.9 +/- 0.8 in the subxiphoid group, respectively, compared to 7.2 +/- 0.8 and 3.4 +/- 0.8 in the control group (p<0.05 for all), respectively. The mean quality of life scores on postoperative Days 1 and 7 were 81.5 +/- 5.0 and 79.3 +/- 7.7, respectively, in the subxiphoid group compared to 72.4 +/- 4.3 and 71.3 +/- 4.8 in the control group, respectively (p<0.05 for all). Postoperative pain and pain mediator indexes were lower in the subxiphoid group (p<0.05 for all). The postoperative tumor recurrence rates were 3.70% and 20.37% in the subxiphoid and control groups, respectively (p=0.008). The five-year survival rates were 85.2% and 63.0% in the subxiphoid and control groups, respectively (p=0.008).Conclusion: Single-port thoracoscopy using the subxiphoid approach is technically feasible, safe, and effective in performing surgery for anterior mediastinal tumors with an intact capsule and a tumor diameter of <= 5 cm.