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

Abstract AIM: To conduct a meta-analysis to determine the relative merits between robot-assisted thymectomy (RAT) and video-assisted thymectomy (VAT) in thymoma treatment. METHODS: A total of 1860 patients who underwent thymectomy were included in this study. A total of 897 patients underwent RAT, 963 patients underwent VAT. Perioperative 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 RAT group and 963 patients in the VAT group. Compared the perioperative outcomes with VAT, reports of RAT indicated favorable outcomes considering the hospital stay (SMD = -1.81, 95% CI -2.09 to -1.53), estimated blood loss (SMD = -12.55, 95% CI -16.68 to -8.42), duration of chest tube insertion (SMD = -0.47, 95% CI -0.63 to -0.31), volume of drainage (SMD = -79.79, 95% CI -90.72 to -68.86), conversion to open (OR= 0.32, 95% CI 0.18 to 0.58). Meanwhile, the sub-group meta-analysis for hospital stay indicated that RAT yielded a significantly shorter time compared with VAT in non-Asian patients (OR= -19.56, 95% CI -29.73 to -9.39). Operative time and ICU stay with RAT were not significantly different from VAT (SMD = 1.09; 95% CI -2.35 to 4.53; P = 0.53), (SMD = -0.13; 95% CI -0.32 to 0.06; P = 0.17). The mortality and complications （group and sub-group analysis） rates in both groups were comparable (OR 0.64, 95% CI 0.17–0.24; P = 0.52), (OR 0.92, 95% CI 0.48–1.77; P = 0.80). CONCLUSION: Our study suggests that the RATapproach is a feasible alternative approach and even a better option for thymoma surgery treatment. Further studies are required to confirm these results.