Efficacy And Long-term Postoperative Pain Analysis Of Thoracoscopic Anterior Mediastinal Tumor Resection By Subxiphoid Approach

Objectives: Thoracoscopic surgery through subxiphoid approach appears as an emerging minimally invasive thoracic surgery.Compared with the traditional intercostal thoracoscopic surgery,its feasibility,safety and clinical efficacy are similar,with milder perioperative pain.In recent years,this technique gains increasing popularity in thoracic surgery.However,whether this surgery can reduce long-term postoperative pain is still lack of evidence.The present study conducted a retrospective analysis of patients who underwent anterior mediastinal tumor resection in Peking University Shenzhen Hospital using Propensity Score Matching(PSM)and other methods and aimed to compare the efficacy and long-term postoperative pain of anterior mediastinal tumor resection by subxiphoid process approach and intercostal approach.Methods: 197 patients who underwent anterior mediastinal tumor resection in the Department of Thoracic Surgery of Peking University Shenzhen Hospital from February 2015 to September 2018 were enrolled.There were 30 cases were excluded.3 of them suffered from chronic pain before surgery,10 cases were intraoperative conversion to median sternotomy,and 17 lost follow-up.Ultimately there were 167 cases were enrolled in the study,42(25.1%)received subxiphoid approach and 125(74.9%)received intercostal approach.The pain degree was expressed by the Numeric Rating Scale(NRS),and the mean time between the follow-up date and the surgery date was 33.6 months.The PSM was performed to reduce the selection bias between both operation groups,and the efficacy and long-term postoperative pain degree of both groups were compared between the matched groups.Results: During the follow-up,there was no new case developed myasthenia gravis(MG),tumor recurrence or death in both groups.After 1:1 PSM between both groups,42 patients in the subxiphoid approach group and 42 patients in the intercostal approach group were enrolled.There was no significant difference in population baseline characteristic variables between the two groups(P > 0.05).No significant statistical difference was revealed between the intercostal approach group and the subxiphoid approach group in intraoperative bleeding,surgery duration,postoperative drainage,postoperative complications,increased postoperative infection index,ICU stay and average hospital stay(P > 0.05).There was no significant difference in the incidence,grade and NRS rates of long-term postoperative pain between the two groups(P > 0.05).Conclusions: Thoracoscopic anterior mediastinal tumor resection by subxiphoid approach represents a safe and feasible surgical technique,which is as effective as the intercostal approach.Our study demonstrated was no significant advantage in relieving long-term postoperative pain in the subxiphoid approach group compared with the intercostal approach group.