To explore the safety and availability of video-assisted thoracic surgery for anterior mediastinal tumors via subxiphoid.

A retrospective analysis was performed with anterior mediastinal tumors undertaken VATS resection via subxiphoid or lateral intercostal approaches from Jul. 2017 to May 2021 in the PLA General Hospital. Each group included 54 patients. The clinical characteristics and early surgical outcomes of these patients were reviewed and analyzed.

Patients in the subxiphoid approach group had more myasthenia gravis (MG) than that in the intercostal group. There was no significant difference in the maximal tumor diameter between two groups. One patient of 54 patients in the subxiphoid approach group was switched to sternotomy due to the serious invading left innominate vein of a thymic carcinoma. Compared with the lateral intercostal approach, the duration of the procedure via the subxiphoid approach was significantly longer (P<0.05), the pain scores on postoperative days 2 was significantly lower (P<0.05). There was no significant difference in the intraoperative blood loss, duration of chest drainage and postoperative drainage volume between two groups. However, in the later stage subgroup of the subxiphoid approach, duration of chest drainage, postoperative drainage volume and postoperative pain were significantly lower than those in lateral intercostal approach. There was no significant difference in the operative duration and the intraoperative blood loss between the later stage subgroup of the subxiphoid approach and contemporary lateral intercostal approach group. Patients in subxiphoid approach group had lower postoperative pain than those in lateral intercoastal group on postoperative 3 months(P<0.05).

Video-assisted thoracic surgery for anterior mediastinal tumors via subxiphoid had a good surgical field of vision and safety. After getting through the learning curve of about 20 cases, the subxiphoid approach has faster recovery after surgery with advantages of shorter duration of chest drainage, less postoperative drainage volume and better quality of life compared with the lateral intercoastal approach.