Acute and chronic pain after subxiphoid versus transcostal thoracoscopic extended thymectomy: A propensity score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Jianfei ^1,2 , WANG Gaoxiang ² , TAO Shanming ^1,2 , XU Liangdong ² , WU Mingsheng ² ,  XIE Mingran ²

1. Graduate School of Wannan Medical College, Wuhu, 241000, Anhui, P. R. China;
2. Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, P. R. China;

Corresponding author：

XIE Mingran, Email: xmr1981@ustc.edu.cn

Keywords：

Thymoma; thoracoscopic surgery; extended thymectomy; postoperative pain; propensity score matching study

DOI：

10.7507/1007-4848.202210009

Video：

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Objective To compare and analyze the occurrence of acute and chronic pain after subxiphoid and transcostal thoracoscopic extended thymectomy. Methods A retrospective analysis was performed on 150 patients who underwent thoracoscopic extended thymectomy in our hospital from July 2020 to June 2022, among whome 30 patients received subxiphoid video-assisted thoracic surgery, and 120 patients received transcostal video-assisted thoracic surgery. The patients were matched by the propensity score matching method. Postoperative pain was evaluated by numeric rating scale (NRS). The intraoperative conditions and postoperative pain incidence were compared between the two groups. Results After matching, 60 patients were enrolled, 30 in each group, including 30 males and 30 females with an average age of 50.78±12.13 years. There was no difference in the general clinical data between the two groups (P>0.05), and no perioperative death. There were statistical differences in the intraoperative blood loss, postoperative drainage volume, postoperative catheter duration, postoperative hospital stay, postoperative pain on 1 d, 2 d, 3 d, 7 d, 3 months and 6 months after the surgery (P<0.05), but there was no statistical difference in the operation time or the postoperative 14 d NRS score (P>0.05). Further univariate and multivariate analyses for postoperative chronic pain showed that surgical method and postoperative 14 d NRS score were risk factors for chronic pain at the 3 months and 6 months after the surgery (P<0.05). Conclusion The subxiphoid thoracoscopic extended thymectomy has advantages over transcostal thoracoscopic surgery in the postoperative acute and chronic pain.

Citation： YANG Jianfei, WANG Gaoxiang, TAO Shanming, XU Liangdong, WU Mingsheng, XIE Mingran. Acute and chronic pain after subxiphoid versus transcostal thoracoscopic extended thymectomy: A propensity score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(6): 842-847. doi: 10.7507/1007-4848.202210009 Copy

1.	Kumar A, Asaf BB, Pulle MV, et al. Minimal access surgery for thymoma. Indian J Surg Oncol, 2020, 11(4): 625-632.
2.	Zhang Y, Li Z, Chen Y, et al. Induction strategy for locally advanced thymoma. Front Oncol, 2021, 11: 704220.
3.	谷志涛, 方文涛. 胸腺肿瘤微创切除手术的基本原则与质量控制. 中国胸心血管外科临床杂志, 2019, 26(1): 29-34.
4.	Gao J, Jin C, Ao YQ, et al. Minimally invasive thymectomy for myasthenia gravis: A 7-year retrospective study. Gland Surg, 2021, 10(12): 3342-3350.
5.	Yang CJ, Hurd J, Shah SA, et al. A national analysis of open versus minimally invasive thymectomy for stageⅠtoⅢ thymoma. J Thorac Cardiovasc Surg, 2020, 160(2): 555-567.
6.	Nguyen TG, Nguyen NT, Nguyen VN, et al. Video-assisted thoracoscopic surgery for myasthenia gravis with thymoma: A six-year single-center experience. Asian J Surg, 2021, 44(1): 369-373.
7.	Lv L, Li W, Men W, et al. Comparing the safety and efficacy of thoracoscopic surgery and thoracotomy for thymoma: A systematic review and meta-analysis. Gland Surg, 2021, 10(12): 3378-3388.
8.	Akamine S, Takahashi T, Oka T, et al. Thymic cystectomy through subxyphoid by video-assisted thoracic surgery. Ann Thorac Surg, 1999, 68(6): 2339-2341.
9.	Suda T, Hachimaru A, Tochii D, et al. Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: Initial results. Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i54-i58.
10.	Pompili C, Trevis J, Patella M, et al. European Society of Thoracic Surgeons electronic quality of life application after lung resection: Field testing in a clinical setting. Interact Cardiovasc Thorac Surg, 2021, 32(6): 911-920.
11.	Zhang L, Li M, Jiang F, et al. Subxiphoid versus lateral intercostal approaches thoracoscopic thymectomy for non-myasthenic early-stage thymoma: A propensity score-matched analysis. Int J Surg, 2019, 67: 13-17.
12.	Qiu Z, Chen L, Lin Q, et al. Perioperative outcomes and mid-term effects in performing video-assisted thoracoscopic extended thymectomy for myasthenia gravis: Subxiphoid versus right thoracic approaches. J Thorac Dis, 2020, 12(4): 1529-1539.
13.	Mizukami Y, Takahashi Y, Adachi H. Single-port vs. conventional three-port video-assisted thoracoscopic pulmonary wedge resection: Comparison of postoperative pain and surgical costs. Ann Thorac Cardiovasc Surg, 2021, 27(2): 91-96.
14.	Zhang Y, Zhou R, Hou B, et al. Incidence and risk factors for chronic postsurgical pain following video-assisted thoracoscopic surgery: A retrospective study. BMC Surg, 2022, 22(1): 76.
15.	Takenaka S, Saeki A, Sukenaga N, et al. Acute and chronic neuropathic pain profiles after video-assisted thoracic surgery: A prospective study. Medicine (Baltimore), 2020, 99(13): e19629.
16.	Cattoni M, Rotolo N, Mastromarino MG, et al. Chronic chest pain and paresthesia after video-assisted thoracoscopy for primary pneumothorax. J Thorac Dis, 2021, 13(2): 613-620.
17.	Erdogan E, Ozenc E. Factors associated with acute and chronic pain after inguinal herniorraphy. Rom J Anaesth Intensive Care, 2018, 25(1): 31-35.

1. Kumar A, Asaf BB, Pulle MV, et al. Minimal access surgery for thymoma. Indian J Surg Oncol, 2020, 11(4): 625-632.
2. Zhang Y, Li Z, Chen Y, et al. Induction strategy for locally advanced thymoma. Front Oncol, 2021, 11: 704220.
3. 谷志涛, 方文涛. 胸腺肿瘤微创切除手术的基本原则与质量控制. 中国胸心血管外科临床杂志, 2019, 26(1): 29-34.
4. Gao J, Jin C, Ao YQ, et al. Minimally invasive thymectomy for myasthenia gravis: A 7-year retrospective study. Gland Surg, 2021, 10(12): 3342-3350.
5. Yang CJ, Hurd J, Shah SA, et al. A national analysis of open versus minimally invasive thymectomy for stageⅠtoⅢ thymoma. J Thorac Cardiovasc Surg, 2020, 160(2): 555-567.
6. Nguyen TG, Nguyen NT, Nguyen VN, et al. Video-assisted thoracoscopic surgery for myasthenia gravis with thymoma: A six-year single-center experience. Asian J Surg, 2021, 44(1): 369-373.
7. Lv L, Li W, Men W, et al. Comparing the safety and efficacy of thoracoscopic surgery and thoracotomy for thymoma: A systematic review and meta-analysis. Gland Surg, 2021, 10(12): 3378-3388.
8. Akamine S, Takahashi T, Oka T, et al. Thymic cystectomy through subxyphoid by video-assisted thoracic surgery. Ann Thorac Surg, 1999, 68(6): 2339-2341.
9. Suda T, Hachimaru A, Tochii D, et al. Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: Initial results. Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i54-i58.
10. Pompili C, Trevis J, Patella M, et al. European Society of Thoracic Surgeons electronic quality of life application after lung resection: Field testing in a clinical setting. Interact Cardiovasc Thorac Surg, 2021, 32(6): 911-920.
11. Zhang L, Li M, Jiang F, et al. Subxiphoid versus lateral intercostal approaches thoracoscopic thymectomy for non-myasthenic early-stage thymoma: A propensity score-matched analysis. Int J Surg, 2019, 67: 13-17.
12. Qiu Z, Chen L, Lin Q, et al. Perioperative outcomes and mid-term effects in performing video-assisted thoracoscopic extended thymectomy for myasthenia gravis: Subxiphoid versus right thoracic approaches. J Thorac Dis, 2020, 12(4): 1529-1539.
13. Mizukami Y, Takahashi Y, Adachi H. Single-port vs. conventional three-port video-assisted thoracoscopic pulmonary wedge resection: Comparison of postoperative pain and surgical costs. Ann Thorac Cardiovasc Surg, 2021, 27(2): 91-96.
14. Zhang Y, Zhou R, Hou B, et al. Incidence and risk factors for chronic postsurgical pain following video-assisted thoracoscopic surgery: A retrospective study. BMC Surg, 2022, 22(1): 76.
15. Takenaka S, Saeki A, Sukenaga N, et al. Acute and chronic neuropathic pain profiles after video-assisted thoracic surgery: A prospective study. Medicine (Baltimore), 2020, 99(13): e19629.
16. Cattoni M, Rotolo N, Mastromarino MG, et al. Chronic chest pain and paresthesia after video-assisted thoracoscopy for primary pneumothorax. J Thorac Dis, 2021, 13(2): 613-620.
17. Erdogan E, Ozenc E. Factors associated with acute and chronic pain after inguinal herniorraphy. Rom J Anaesth Intensive Care, 2018, 25(1): 31-35.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Acute and chronic pain after subxiphoid versus transcostal thoracoscopic extended thymectomy: A propensity score matching study

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