Robot versus video-assisted thoracoscopic thymectomy for large thymic epithelial tumors: a propensity-matched analysis.

BACKGROUND: Both video-assisted thoracoscopic surgery (VATS) thymectomy and robot-assisted thoracoscopic surgery (RATS) thymectomy have been suggested as technically sound approaches for early-stage thymic epithelial tumors. However, the choice of VATS or RATS thymectomy for large and advanced thymic epithelial tumors remains controversial. In this study, the perioperative outcomes of VATS and RATS thymectomy were compared in patients with large thymic epithelial tumors (size ≥5.0 cm). METHODS: A total of 113 patients with large thymic epithelial tumors who underwent minimally invasive surgery were included. Sixty-three patients underwent RATS, and 50 patients underwent VATS. Patient characteristics and perioperative variables were compared. RESULTS: Compared with the VATS group, the RATS group experienced a shorter operation time (median: 110 min vs.130 min; P < 0.001) and less blood loss (30.00 ml vs. 100.00 ml, P < 0.001). No patients in the RATS group needed conversion to open surgery, but in the VATS series, five patients required conversion to open procedures (0% vs. 14.29%, P = 0.054). The rate of concomitant resection in the RATS group was similar to that in the VATS group (11.43% vs. 5.71%; P = 0.673). There was no significant difference between the two groups in the duration of chest tube (P = 0.587), postoperative complications (P = 1.000), and the duration of postoperative hospital stay (P = 0.141). CONCLUSION: For large thymic epithelial tumors, RATS thymectomy can be performed safely and effectively in a radical fashion. Due to the advanced optics and precise instrument control, concomitant resections can be easily achieved in larger thymic epithelial tumors using the robotic approach.

Robot-assisted thymectomy in large anterior mediastinal tumors: A comparative study with video-assisted thymectomy and open surgery.

BACKGROUND: The aim of this study was to evaluate the safety and effectiveness of robot-assisted thymectomy (RAT) in large anterior mediastinal tumors (AMTs) (size ≥6 cm) compared with video-assisted thymectomy (VAT) and open surgery. METHODS: A total of 132 patients with large AMTs who underwent surgical resection from January 2016 to June 2022 were included in this study. A total of 61 patients underwent RAT, 36 patients underwent VAT and 35 patients underwent open surgery. Perioperative outcomes were compared. RESULTS: There were no significant differences in tumor size (p = 0.141), or pathological types (p = 0.903). Compared with the open group, the RAT and VAT groups were associated with a shorter operation time (115.00 vs. 160.00, p = 0.012; 122.50 vs. 160.00, p = 0.071), and less blood loss (50.00 vs. 200.00, p < 0.001; 50.00 vs. 200.00, p < 0.001), respectively. The rate of conversion in the RAT group was similar to that in the VAT group (6.56% vs. 13.89%, p = 0.229). Concomitant resection was less frequently performed in the VAT group than in the RAT and open groups (5.56% vs. 31.15%, p = 0.040; 5.56% vs. 31.43%, p = 0.006). VAT patients had a lower drainage volume (365.00 vs. 700.00 and 910.00 mL, p < 0.001), shorter duration of chest tube (2.00 vs. 3.00 and 4.00, p < 0.001), and shorter hospital stay (5.00 vs. 6.00 and 7.00, p < 0.001) than the RAT and open groups. There was no 30-day mortality in any group. No difference was seen in R0 resection rates (p = 0.846). The postoperative complication rates were similar among the three groups (p = 0.309). Total in-hospital costs (66493.90 vs. 33581.05 and 42876.40, p < 0.001) were significantly higher in the RAT group. CONCLUSIONS: RAT is safe and effective for the resection of large AMTs compared to VAT and open surgery. Vascular resection in RAT is technically feasible. A long-term follow-up is required.

[Effects of freeze-thaw and soil moisture on content and spectral structure properties of dissolved organic matter in forest soil leachates.] / å†»èžæ¡ä»¶å’ŒåœŸå£¤æ¹¿åº¦å¯¹æ£®æž—åœŸå£¤æ¸—æ¼æ¶²æº¶è§£æ€§æœ‰æœºè´¨å«é‡ä¸Žå ‰è°±ç»“æž„ç‰¹å¾çš„å½±å“.

The contents and stability of soil dissolved organic matter (DOM) can affect key processes of soil carbon and nitrogen cycle. The responses of DOM content and its spectral structure pro-perties in forest soils to climate change remain unclear. We collected soil samples from two temperate forests, i.e., the broadleaf and Korean pine mixed forest (BKPF) and adjacent secondary white birch forest (WBF), in Changbai Mountains, northeastern China. Using a combination of three-dimensional fluorescence spectrum and parallel factor analysis, a simulated freeze-thaw experiment was conducted in the laboratory. We examined the effects of freeze-thaw intensity, freeze-thaw cycle and their interaction on the content, components and spectral properties of DOM leached from the two forest surface soils with different moisture levels. The results showed that DOM content and components of soil leachates varied with forest types, soil moisture, freeze-thaw intensity and freeze-thaw cycle. The DOM content in the leachates was lowest at medium moisture level and was significantly affected by the high freeze-thaw intensity. In addition, the DOM content increased first and then decreased with the increases of freeze-thaw cycles. Three fluorescence components of DOM in the forest soil leachates were identified as humic acid-like DOM, fulvic acid-like DOM and protein-like DOM. The DOM components of BKPF soil leachates were mainly consisted of fulvic acid-like substances with a high humification index. However, the DOM from WBF soil leachates was dominated by humic acid-like substances with low stability, and the three fluorescence components were significantly affected by the freeze-thaw intensity. Results from the redundancy analysis showed that under the experimental conditions, forest type played a leading role in changing DOM properties. The DOM content and its three fluorescence intensities of WBF soil leachates were higher than those of BKPF. Soil moisture significantly affected the aromaticity of DOM in the forest soil leachates, and the DOM aromaticity of soil leachates from the two forest stands ranked as medium moisture > high moisture > low moisture. With the increases of freeze-thaw intensity, the DOM aromaticity of BKPF soil leachates significantly decreased. Furthermore, the increases of freeze-thaw cycles significantly increased the humification degree of DOM in the forest soil leachates. Therefore, upon different freeze-thaw disturbance, the DOM content and bioavailability of soil leachates with low moisture tended to increase, particularly in the WBF soil leachates, which may result in an increased lea-ching of DOM in temperate forest soils during spring freeze-thaw periods. The results provide a refe-rence for further investigating DOM turnover in temperate forest soils during spring freeze-thaw periods.