Background Thoracoscopic thymectomy is increasingly performed for the treatment of early stage thymoma. It is characterized by shorter postoperative hospital stay, decreased intraoperative blood loss, and fewer complications compared with transsternal thymectomy. Unilateral video-assisted thoracic surgery (VATS) thymectomy can be easily performed from either side of the thorax, because thymus is located in the middle of mediastinum. However, the side that provides better outcomes remains controversial. The purpose of this study was to compare the efficacy of right and left approaches in performing unilateral thoracoscopic thymectomy for thymoma.

Methods Consecutive patients affected by thymoma who underwent VATS thymectomy on either side between February 2001 and March 2020 were enrolled in the study. Clinicopathologic, surgical, and oncological outcomes were retrospectively analyzed and compared among the two surgical approaches.

Results Unilateral VATS approaches were performed on 29 patients: 12 (41%) on the left side and 17 (59%) on the right side. The mean age was 63.1 ± 11.3 years and the female/male ratio was 1.73:1. The mean operative time and the hospital stay for the left-side VATS and right-side VATS groups were, respectively, 168 ± 49.5 versus 171 ± 47.9 minutes (p = 0.9) and 3 ± 1.03 days versus 3.65 ± 1.93 days (p = 0.7). Postoperative complications occurred in one patient (3%) for left-side VATS group and one patient (3%) for right-side VATS. The 5-year disease-free survival was comparable between two groups (p = 0.74).

Conclusions Unilateral VATS thymectomy in patients with thymoma can be safely and effectively performed by experienced surgeons in either side of the thorax with equivalent oncological outcomes.

背景 胸腔镜胸腺切除术越来越多地用于治疗早期胸腺瘤。与经胸骨胸腺切除术相比，其特点是术后住院时间短、术中失血量少、并发症少。单侧电视辅助胸腔手术 (VATS) 胸腺切除术可以轻松地从胸廓的任一侧进行，因为胸腺位于纵隔中部。然而，哪一方能提供更好的结果仍然存在争议。本研究的目的是比较左右入路对胸腺瘤进行单侧胸腔镜胸腺切除术的疗效。

方法 2001年2月至2020年3月期间连续接受两侧VATS胸腺切除术的胸腺瘤患者纳入研究。对两种手术方法的临床病理、手术和肿瘤学结果进行回顾性分析和比较。

结果 29 名患者接受了单侧 VATS 入路：左侧 12 例（41%），右侧 17 例（59%）。平均年龄为 63.1 ± 11.3 岁，女性/男性比例为 1.73:1。左侧 VATS 组和右侧 VATS 组的平均手术时间和住院时间分别为 168 ± 49.5 分钟 vs 171 ± 47.9 分钟 ( p = 0.9) 和 3 ± 1.03 天 vs 3.65 ± 1.93天 ( p  = 0.7）。左侧 VATS 组有 1 名患者（3%）发生术后并发症，右侧 VATS 组有 1 名患者（3%）发生术后并发症。两组的 5 年无病生存率相当 ( p  = 0.74)。

结论 经验 丰富的外科医生可以安全有效地对胸腺瘤患者进行单侧 VATS 胸腺切除术，并获得相同的肿瘤学结果。