Objective:

To compare perioperative, neurological, and short-term oncologic outcomes between subxiphoid and lateral intercostal approaches in video-assisted thoracoscopic extended thymectomy (VATET).

Approach:

Key Findings:

• Baseline characteristics and histopathological features were comparable between groups (P > 0.05).
• The ICA group had lower intraoperative blood loss, shorter postoperative stay, shorter drainage duration, and lower hospitalization costs (all P < 0.05).
• VAS scores on postoperative days 1, 3, and 7 were lower in the SA group (all P < 0.001).
• Complication rates were similar between groups (8.24% vs. 6.02%, P > 0.05).
• Neurological outcomes in myasthenia gravis were similar between groups.
• Thymoma recurrence occurred in two patients in each group.

Interpretation:

Both approaches are safe and feasible for VATET. The lateral intercostal approach improves operative efficiency, while the subxiphoid approach reduces early postoperative pain without affecting neurological or short-term oncologic outcomes.

Conclusion:

Both surgical approaches are viable for VATET, with distinct advantages in terms of pain management and operative efficiency.

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