Chinese expert consensus on subxiphoid video-assisted thoracoscopic surgery with sternal elevation for anterior mediastinal masses_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 FAN Jiang ¹ ,  CHEN Longqi ² , Mediastinal Group, Thoracic Surgery Branch, Shanghai Medical Doctor Association, Thoracic Surgery Branch , Sichuan International Medical Exchange and Promotion Association

1. Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, P. R. China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding?author：

FAN Jiang, Email: fan_jiang@sjtu.edu.cn; CHEN Longqi, Email: drchenlq@scu.edu.cn

Keywords：

Sternal elevation; subxiphoid approach; anterior mediastinal mass; video-assisted thoracoscopic surgery; expert consensus

DOI：

10.7507/1007-4848.202506008

Video：

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With the adoption of the surgical principles emphasizing minimally invasive, precise, and individualized procedures, the sternum elevation via the subxiphoid approach for thoracoscopic surgery has become an important technique for the resection of anterior mediastinal masses. This method offers significant advantages in terms of increasing surgical field exposure, reducing surgical trauma, alleviating postoperative pain, and improving cosmetic outcomes. To establish a standardized surgical system and promote the consistent implementation of this technique, this consensus integrates the practical experiences of multiple thoracic surgery centers in China and relevant literature reports. It addresses core clinical issues such as surgical indications, preoperative assessment, anesthesia and intraoperative cooperation, key surgical techniques, postoperative management, prevention and treatment of complications, as well as training and quality control systems. The aim is to provide a safer and more effective minimally invasive solution for patients with anterior mediastinal masses and to facilitate the innovation of minimally invasive surgical modalities for the anterior mediastinum.

Citation： FAN Jiang, CHEN Longqi, Mediastinal Group, Thoracic Surgery Branch, Shanghai Medical Doctor Association, Thoracic Surgery Branch, Sichuan International Medical Exchange and Promotion Association. Chinese expert consensus on subxiphoid video-assisted thoracoscopic surgery with sternal elevation for anterior mediastinal masses. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(7): 887-896. doi: 10.7507/1007-4848.202506008 Copy

1.	Wang S, Yang X, Jiang J, et al. Subxiphoid versus lateral intercostal thoracoscopic thymectomy for suspected thymoma: Results of a randomized controlled trial. J Thorac Cardiovasc Surg, 2024, 168(1): 290-298.
2.	Chen W, Tang H, Yu Z, et al. Clinical outcomes of subxiphoid uniportal video-assisted thoracoscopic thymectomy using a double sternum retractor versus conventional approaches. J Thorac Dis, 2025, 17(5): 3200-3209.
3.	趙金蘭, 陳蔚洋, 何春梅, 等. "天平拉鉤抬高胸骨法"在經劍突下單孔胸腔鏡輔助前縱隔腫物切除術中的應用. 中國胸心血管外科臨床雜志, 2025, 32(3): 308-312.Zhao JL, Chen WY, He CM, et al. Application of "balance-shaped sternal elevation device" in the subxiphoid uniportal video-assisted thoracoscopic surgery for anterior mediastinal masses resection. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(3): 308-312.
4.	Takeo S, Fukuyama S. Video-assisted thoracoscopic resection of a giant anterior mediastinal tumor (lipoma) using an original sternum-lifting technique. Jpn J Thorac Cardiovasc Surg, 2005, 53(10): 565-568.
5.	Alonso-Coello P, Schünemann HJ, Moberg J, et al. GRADE evidence to decision (EtD) frameworks: A systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ, 2016, 353: i2016.
6.	Falkson CB, Vella ET, Ellis PM, et al. Surgical, radiation, and systemic treatments of patients with thymic epithelial tumors: A systematic review. J Thorac Oncol, 2023, 18(3): 299-312.
7.	Zhang Y, Lin D, Aramini B, et al. Thymoma and thymic carcinoma: Surgical resection and multidisciplinary treatment. Cancers (Basel), 2023, 15(7): 1953.
8.	Wolfe GI, Kaminski HJ, Aban IB, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med, 2016, 375(6): 511-522.
9.	Wang X, Aramini B, Xu H, et al. Thymectomy with angioplasty through a thoracoscopic subxiphoid approach with double elevation of the sternum in Masaoka stageⅢthymoma. JTCVS Tech, 2021, 8: 208-210.
10.	Song N, Li Q, Aramini B, et al. Double sternal elevation subxiphoid versus uniportal thoracoscopic thymectomy associated with superior clearance for stage Ⅰ-Ⅱthymic epithelial tumors: Subxiphoid thymectomy compared with VATS. Surgery, 2022, 172(1): 371-378.
11.	Juanpere S, Ca?ete N, Ortu?o P, et al. A diagnostic approach to the mediastinal masses. Insights Imaging, 2013, 4(1): 29-52.
12.	Bourgouin PP, Madan R. Imaging of the middle and visceral mediastinum. Radiol Clin North Am, 2021, 59(2): 193-204.
13.	Carter BW, Betancourt SL, Benveniste MF. MR imaging of mediastinal masses. Top Magn Reson Imaging, 2017, 26(4): 153-165.
14.	Raptis CA, McWilliams SR, Ratkowski KL, et al. Mediastinal and pleural MR imaging: Practical approach for daily practice. Radiographics, 2018, 38(1): 37-55.
15.	El-Galaly TC, Villa D, Gormsen LC, et al. FDG-PET/CT in the management of lymphomas: Current status and future directions. J Intern Med, 2018, 284(4): 358-376.
16.	Civan C, Ozkan ZG, Ozkan B, et al. The role of [18F]FDG PET/CT in the characterization of thymic epithelial tumors at initial stage. Cancer Biother Radiopharm, 2024, 39(5): 373-380.
17.	Wang X, Aramini B, Zhu Y, et al. Management of bleeding complications during thymectomy by subxiphoid approach with double elevation of the sternum: A case report. Mediastinum, 2021, 5: 10.
18.	中國醫師協會胸外科醫師分會縱隔及胸壁學組, 中國研究型醫院學會胸外科學專業委員會, 中國醫療保健國際交流促進會肺癌防治分會, 等. 2022縱隔及胸壁腫瘤圍手術期及全程化綜合診治中國專家共識. 中國胸心血管外科臨床雜志, 2023, 30(3): 325-332.Mediastinum and Chest Wall Group of Thoracic Surgeon Branch of Chinese Medical Doctor Association, Thoracic Surgery Committee of Chinese Research Hospital Association, Lung Cancer Prevention Branch of China International Exchange and Promotive Association for Medical and Health Care, et al. 2022 Chinese expert consensus on perioperative and whole-course diagnosis and treatment of mediastinal and chest wall tumors. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(3): 325-332.
19.	Caposole MZ, Aruca-Bustillo V, Mitchell M, et al. Benign metachronous bilateral ovarian and mediastinal teratomas with an elevated alpha-fetoprotein. Ann Thorac Surg, 2015, 99(3): 1073-1075.
20.	Gilhus NE. Myasthenia gravis. N Engl J Med, 2016, 375(26): 2570-2581.
21.	Zielinski M, Czajkowski W, Gwozdz P, et al. Resection of thymomas with use of the new minimally-invasive technique of extended thymectomy performed through the subxiphoid-right video-thoracoscopic approach with double elevation of the sternum. Eur J Cardiothorac Surg, 2013, 44(2): e113-e119.
22.	Aramini B, Song N, Banchelli F, et al. Subxiphoid thymectomy with a double sternum retractor: A pilot study. Gland Surg, 2019, 8(6): 657-662.
23.	Toker A, Sonett J, Zielinski M, et al. Standard terms, definitions, and policies for minimally invasive resection of thymoma. J Thorac Oncol, 2011, 6(7 Suppl 3): S1739-S1742.
24.	Kondo K, Van Schil P, Detterbeck FC, et al. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: Proposals for the N and M components for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2014, 9(9 Suppl 2): S81-S87.
25.	Detterbeck FC, Moran C, Huang J, 等. 外科醫生和病理醫生對胸腺惡性腫瘤切除標本的處理方法和程序. 中國肺癌雜志, 2014, 17(2): 95-103.Detterbeck FC, Moran C, Huang J, et al. Which way is up? Policies and procedures for surgeons and pathologists regarding resection specimens of thymic malignancy. Chin J Lung Cancer, 2014, 17(2): 95-103.
26.	Thompson C, French DG, Costache I. Pain management within an enhanced recovery program after thoracic surgery. J Thorac Dis, 2018, 10(Suppl 32): S3773-S3780.
27.	Makkad B, Heinke TL, Sheriffdeen R, et al. Practice advisory for preoperative and intraoperative pain management of thoracic surgical patients: Part 1. Anesth Analg, 2023, 137(1): 2-25.
28.	Qi Y, Zhou M, Zheng W, et al. Effect of S-ketamine on postoperative nausea and vomiting in patients undergoing video-assisted thoracic surgery: A randomized controlled trial. Drug Des Devel Ther, 2024, 18: 1189-1198.
29.	Gómez-Caro A, Roca MJ, Torres J, et al. Successful use of a single chest drain postlobectomy instead of two classical drains: A randomized study. Eur J Cardiothorac Surg, 2006, 29(4): 562-566.
30.	Wu S, Liu J, Liang H, et al. Factors influencing the length of stay after mediastinal tumor resection in the setting of an enhanced recovery after surgery (ERAS)-TUBELESS protocol. Ann Transl Med, 2020, 8(12): 740.
31.	Mesa-Guzman M, Periklis P, Niwaz Z, et al. Determining optimal fluid and air leak cut off values for chest drain management in general thoracic surgery. J Thorac Dis, 2015, 7(11): 2053-2057.
32.	Refai M, Brunelli A, Salati M, et al. The impact of chest tube removal on pain and pulmonary function after pulmonary resection. Eur J Cardiothorac Surg, 2012, 41(4): 820-822.
33.	Alex J, Ansari J, Bahalkar P, et al. Comparison of the immediate postoperative outcome of using the conventional two drains versus a single drain after lobectomy. Ann Thorac Surg, 2003, 76(4): 1046-1049.
34.	Liu Z, Zhang L, Tang W, et al. Non-intubated uniportal subxiphoid thoracoscopic extended thymectomy for thymoma associated with myasthenia gravis. World J Surg Oncol, 2021, 19(1): 342.
35.	Liu Z, Yang R. Comparison of subxiphoid and intercostal uniportal thoracoscopic thymectomy for nonmyasthenic early-stage thymoma: A retrospective single-center propensity-score matching analysis. Thorac Cardiovasc Surg, 2021, 69(2): 173-180.
36.	Agzarian J, Linkins LA, Schneider L, et al. Practice patterns in venous thromboembolism (VTE) prophylaxis in thoracic surgery: A comprehensive Canadian Delphi survey. J Thorac Dis, 2017, 9(1): 80-87.
37.	Di Nisio M, Peinemann F, Porreca E, et al. Primary prophylaxis for venous thromboembolism in patients undergoing cardiac or thoracic surgery. Cochrane Database Syst Rev, 2015, 2015(6): CD009658.
38.	Trinh VQ, Karakiewicz PI, Sammon J, et al. Venous thromboembolism after major cancer surgery: Temporal trends and patterns of care. JAMA Surg, 2014, 149(1): 43-49.
39.	Wang Q, Ding J, Yang R. The venous thromboembolism prophylaxis in patients receiving thoracic surgery: A systematic review. Asia Pac J Clin Oncol, 2021, 17(5): e142-e152.
40.	Yang X, Yu L, Yu T, et al. Venous thromboembolism after adult thymus or thymic tumor resection: A single-center experience. Thorac Cancer, 2020, 11(8): 2291-2296.
41.	李輝, 姜格寧. 胸部惡性腫瘤圍術期靜脈血栓栓塞癥預防中國專家共識(2018版). 中國肺癌雜志, 2018, 21(10): 739-752.Li H, Jiang GN. Perioperative venous thromboembolism (VTE) prophalaxis in thoracic cancer patients: Chinese experts consensus. Chin J Lung Cancer, 2018, 21(10): 739-752.
42.	Odell DD, Peleg K, Givon A, et al. Sternal fracture: Isolated lesion versus polytrauma from associated extrasternal injuries–analysis of 1, 867 cases. J Trauma Acute Care Surg, 2013, 75(3): 448-452.
43.	Doyle JE, Diaz-Gutierrez I. Traumatic sternal fractures: A narrative review. Mediastinum, 2021, 5: 34.
44.	Salati M, Cardillo G, Carbone L, et al. Iatrogenic phrenic nerve injury during thymectomy: The extent of the problem. J Thorac Cardiovasc Surg, 2010, 139(4): e77-e78.
45.	Ostrowska M, de Carvalho M. Prognosis of phrenic nerve injury following thoracic interventions: Four new cases and a review. Clin Neurol Neurosurg, 2012, 114(3): 199-204.
46.	Rowse PG, Roden AC, Corl FM, et al. Minimally invasive thymectomy: The Mayo Clinic experience. Ann Cardiothorac Surg, 2015, 4(6): 519-526.
47.	Kawashima S, Kohno T, Fujimori S, et al. Phrenic nerve reconstruction in complete video-assisted thoracic surgery. Interact Cardiovasc Thorac Surg, 2015, 20(1): 54-59.
48.	Yumoto E, Sanuki T, Kumai Y. Immediate recurrent laryngeal nerve reconstruction and vocal outcome. Laryngoscope, 2006, 116(9): 1657-1661.
49.	Freeman RK, Wozniak TC, Fitzgerald EB. Functional and physiologic results of video-assisted thoracoscopic diaphragm plication in adult patients with unilateral diaphragm paralysis. Ann Thorac Surg, 2006, 81(5): 1853-1857.
50.	Fang Y, Wu J, Zhang M, et al. Conservative rehabilitation therapy for respiratory dysfunction due to phrenic nerve sacrifice during resection of massive mediastinal tumor: A case series study. Medicine (Baltimore), 2023, 102(36): e35117.
51.	Remes-Troche JM, Téllez-Zenteno JF, Esta?ol B, et al. Thymectomy in myasthenia gravis: Response, complications, and associated conditions. Arch Med Res, 2002, 33(6): 545-551.
52.	Agatsuma H, Yoshida K, Yoshino I, et al. Video-assisted thoracic surgery thymectomy versus sternotomy thymectomy in patients with thymoma. Ann Thorac Surg, 2017, 104(3): 1047-1053.
53.	Huang Y, Su L, Zhang Y, et al. Risk factors for postoperative myasthenic crisis after thymectomy in patients with myasthenia gravis. J Surg Res, 2021, 262: 1-5.
54.	Claytor B, Cho SM, Li Y. Myasthenic crisis. Muscle Nerve, 2023, 68(1): 8-19.
55.	Chigurupati K, Gadhinglajkar S, Sreedhar R, et al. Criteria for postoperative mechanical ventilation after thymectomy in patients with myasthenia gravis: A retrospective analysis. J Cardiothorac Vasc Anesth, 2018, 32(1): 325-330.
56.	Suda T, Ishizawa H, Nagano H, et al. Early outcomes in 147 consecutive cases of subxiphoid single-port thymectomy and evaluation of learning curves. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i44-i49.
57.	Toker A, Tanju S, Ziyade S, et al. Learning curve in videothoracoscopic thymectomy: How many operations and in which situations? Eur J Cardiothorac Surg, 2008, 34(1): 155-158.
58.	Meacci E, Nachira D, Congedo MT, et al. Learning curve of robot-assisted thymectomy: Single surgeon’s 7-year experience. Front Surg, 2022, 9: 860899.

1. Wang S, Yang X, Jiang J, et al. Subxiphoid versus lateral intercostal thoracoscopic thymectomy for suspected thymoma: Results of a randomized controlled trial. J Thorac Cardiovasc Surg, 2024, 168(1): 290-298.
2. Chen W, Tang H, Yu Z, et al. Clinical outcomes of subxiphoid uniportal video-assisted thoracoscopic thymectomy using a double sternum retractor versus conventional approaches. J Thorac Dis, 2025, 17(5): 3200-3209.
3. 趙金蘭, 陳蔚洋, 何春梅, 等. "天平拉鉤抬高胸骨法"在經劍突下單孔胸腔鏡輔助前縱隔腫物切除術中的應用. 中國胸心血管外科臨床雜志, 2025, 32(3): 308-312.Zhao JL, Chen WY, He CM, et al. Application of "balance-shaped sternal elevation device" in the subxiphoid uniportal video-assisted thoracoscopic surgery for anterior mediastinal masses resection. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(3): 308-312.
4. Takeo S, Fukuyama S. Video-assisted thoracoscopic resection of a giant anterior mediastinal tumor (lipoma) using an original sternum-lifting technique. Jpn J Thorac Cardiovasc Surg, 2005, 53(10): 565-568.
5. Alonso-Coello P, Schünemann HJ, Moberg J, et al. GRADE evidence to decision (EtD) frameworks: A systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ, 2016, 353: i2016.
6. Falkson CB, Vella ET, Ellis PM, et al. Surgical, radiation, and systemic treatments of patients with thymic epithelial tumors: A systematic review. J Thorac Oncol, 2023, 18(3): 299-312.
7. Zhang Y, Lin D, Aramini B, et al. Thymoma and thymic carcinoma: Surgical resection and multidisciplinary treatment. Cancers (Basel), 2023, 15(7): 1953.
8. Wolfe GI, Kaminski HJ, Aban IB, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med, 2016, 375(6): 511-522.
9. Wang X, Aramini B, Xu H, et al. Thymectomy with angioplasty through a thoracoscopic subxiphoid approach with double elevation of the sternum in Masaoka stageⅢthymoma. JTCVS Tech, 2021, 8: 208-210.
10. Song N, Li Q, Aramini B, et al. Double sternal elevation subxiphoid versus uniportal thoracoscopic thymectomy associated with superior clearance for stage Ⅰ-Ⅱthymic epithelial tumors: Subxiphoid thymectomy compared with VATS. Surgery, 2022, 172(1): 371-378.
11. Juanpere S, Ca?ete N, Ortu?o P, et al. A diagnostic approach to the mediastinal masses. Insights Imaging, 2013, 4(1): 29-52.
12. Bourgouin PP, Madan R. Imaging of the middle and visceral mediastinum. Radiol Clin North Am, 2021, 59(2): 193-204.
13. Carter BW, Betancourt SL, Benveniste MF. MR imaging of mediastinal masses. Top Magn Reson Imaging, 2017, 26(4): 153-165.
14. Raptis CA, McWilliams SR, Ratkowski KL, et al. Mediastinal and pleural MR imaging: Practical approach for daily practice. Radiographics, 2018, 38(1): 37-55.
15. El-Galaly TC, Villa D, Gormsen LC, et al. FDG-PET/CT in the management of lymphomas: Current status and future directions. J Intern Med, 2018, 284(4): 358-376.
16. Civan C, Ozkan ZG, Ozkan B, et al. The role of [18F]FDG PET/CT in the characterization of thymic epithelial tumors at initial stage. Cancer Biother Radiopharm, 2024, 39(5): 373-380.
17. Wang X, Aramini B, Zhu Y, et al. Management of bleeding complications during thymectomy by subxiphoid approach with double elevation of the sternum: A case report. Mediastinum, 2021, 5: 10.
18. 中國醫師協會胸外科醫師分會縱隔及胸壁學組, 中國研究型醫院學會胸外科學專業委員會, 中國醫療保健國際交流促進會肺癌防治分會, 等. 2022縱隔及胸壁腫瘤圍手術期及全程化綜合診治中國專家共識. 中國胸心血管外科臨床雜志, 2023, 30(3): 325-332.Mediastinum and Chest Wall Group of Thoracic Surgeon Branch of Chinese Medical Doctor Association, Thoracic Surgery Committee of Chinese Research Hospital Association, Lung Cancer Prevention Branch of China International Exchange and Promotive Association for Medical and Health Care, et al. 2022 Chinese expert consensus on perioperative and whole-course diagnosis and treatment of mediastinal and chest wall tumors. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(3): 325-332.
19. Caposole MZ, Aruca-Bustillo V, Mitchell M, et al. Benign metachronous bilateral ovarian and mediastinal teratomas with an elevated alpha-fetoprotein. Ann Thorac Surg, 2015, 99(3): 1073-1075.
20. Gilhus NE. Myasthenia gravis. N Engl J Med, 2016, 375(26): 2570-2581.
21. Zielinski M, Czajkowski W, Gwozdz P, et al. Resection of thymomas with use of the new minimally-invasive technique of extended thymectomy performed through the subxiphoid-right video-thoracoscopic approach with double elevation of the sternum. Eur J Cardiothorac Surg, 2013, 44(2): e113-e119.
22. Aramini B, Song N, Banchelli F, et al. Subxiphoid thymectomy with a double sternum retractor: A pilot study. Gland Surg, 2019, 8(6): 657-662.
23. Toker A, Sonett J, Zielinski M, et al. Standard terms, definitions, and policies for minimally invasive resection of thymoma. J Thorac Oncol, 2011, 6(7 Suppl 3): S1739-S1742.
24. Kondo K, Van Schil P, Detterbeck FC, et al. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: Proposals for the N and M components for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2014, 9(9 Suppl 2): S81-S87.
25. Detterbeck FC, Moran C, Huang J, 等. 外科醫生和病理醫生對胸腺惡性腫瘤切除標本的處理方法和程序. 中國肺癌雜志, 2014, 17(2): 95-103.Detterbeck FC, Moran C, Huang J, et al. Which way is up? Policies and procedures for surgeons and pathologists regarding resection specimens of thymic malignancy. Chin J Lung Cancer, 2014, 17(2): 95-103.
26. Thompson C, French DG, Costache I. Pain management within an enhanced recovery program after thoracic surgery. J Thorac Dis, 2018, 10(Suppl 32): S3773-S3780.
27. Makkad B, Heinke TL, Sheriffdeen R, et al. Practice advisory for preoperative and intraoperative pain management of thoracic surgical patients: Part 1. Anesth Analg, 2023, 137(1): 2-25.
28. Qi Y, Zhou M, Zheng W, et al. Effect of S-ketamine on postoperative nausea and vomiting in patients undergoing video-assisted thoracic surgery: A randomized controlled trial. Drug Des Devel Ther, 2024, 18: 1189-1198.
29. Gómez-Caro A, Roca MJ, Torres J, et al. Successful use of a single chest drain postlobectomy instead of two classical drains: A randomized study. Eur J Cardiothorac Surg, 2006, 29(4): 562-566.
30. Wu S, Liu J, Liang H, et al. Factors influencing the length of stay after mediastinal tumor resection in the setting of an enhanced recovery after surgery (ERAS)-TUBELESS protocol. Ann Transl Med, 2020, 8(12): 740.
31. Mesa-Guzman M, Periklis P, Niwaz Z, et al. Determining optimal fluid and air leak cut off values for chest drain management in general thoracic surgery. J Thorac Dis, 2015, 7(11): 2053-2057.
32. Refai M, Brunelli A, Salati M, et al. The impact of chest tube removal on pain and pulmonary function after pulmonary resection. Eur J Cardiothorac Surg, 2012, 41(4): 820-822.
33. Alex J, Ansari J, Bahalkar P, et al. Comparison of the immediate postoperative outcome of using the conventional two drains versus a single drain after lobectomy. Ann Thorac Surg, 2003, 76(4): 1046-1049.
34. Liu Z, Zhang L, Tang W, et al. Non-intubated uniportal subxiphoid thoracoscopic extended thymectomy for thymoma associated with myasthenia gravis. World J Surg Oncol, 2021, 19(1): 342.
35. Liu Z, Yang R. Comparison of subxiphoid and intercostal uniportal thoracoscopic thymectomy for nonmyasthenic early-stage thymoma: A retrospective single-center propensity-score matching analysis. Thorac Cardiovasc Surg, 2021, 69(2): 173-180.
36. Agzarian J, Linkins LA, Schneider L, et al. Practice patterns in venous thromboembolism (VTE) prophylaxis in thoracic surgery: A comprehensive Canadian Delphi survey. J Thorac Dis, 2017, 9(1): 80-87.
37. Di Nisio M, Peinemann F, Porreca E, et al. Primary prophylaxis for venous thromboembolism in patients undergoing cardiac or thoracic surgery. Cochrane Database Syst Rev, 2015, 2015(6): CD009658.
38. Trinh VQ, Karakiewicz PI, Sammon J, et al. Venous thromboembolism after major cancer surgery: Temporal trends and patterns of care. JAMA Surg, 2014, 149(1): 43-49.
39. Wang Q, Ding J, Yang R. The venous thromboembolism prophylaxis in patients receiving thoracic surgery: A systematic review. Asia Pac J Clin Oncol, 2021, 17(5): e142-e152.
40. Yang X, Yu L, Yu T, et al. Venous thromboembolism after adult thymus or thymic tumor resection: A single-center experience. Thorac Cancer, 2020, 11(8): 2291-2296.
41. 李輝, 姜格寧. 胸部惡性腫瘤圍術期靜脈血栓栓塞癥預防中國專家共識(2018版). 中國肺癌雜志, 2018, 21(10): 739-752.Li H, Jiang GN. Perioperative venous thromboembolism (VTE) prophalaxis in thoracic cancer patients: Chinese experts consensus. Chin J Lung Cancer, 2018, 21(10): 739-752.
42. Odell DD, Peleg K, Givon A, et al. Sternal fracture: Isolated lesion versus polytrauma from associated extrasternal injuries–analysis of 1, 867 cases. J Trauma Acute Care Surg, 2013, 75(3): 448-452.
43. Doyle JE, Diaz-Gutierrez I. Traumatic sternal fractures: A narrative review. Mediastinum, 2021, 5: 34.
44. Salati M, Cardillo G, Carbone L, et al. Iatrogenic phrenic nerve injury during thymectomy: The extent of the problem. J Thorac Cardiovasc Surg, 2010, 139(4): e77-e78.
45. Ostrowska M, de Carvalho M. Prognosis of phrenic nerve injury following thoracic interventions: Four new cases and a review. Clin Neurol Neurosurg, 2012, 114(3): 199-204.
46. Rowse PG, Roden AC, Corl FM, et al. Minimally invasive thymectomy: The Mayo Clinic experience. Ann Cardiothorac Surg, 2015, 4(6): 519-526.
47. Kawashima S, Kohno T, Fujimori S, et al. Phrenic nerve reconstruction in complete video-assisted thoracic surgery. Interact Cardiovasc Thorac Surg, 2015, 20(1): 54-59.
48. Yumoto E, Sanuki T, Kumai Y. Immediate recurrent laryngeal nerve reconstruction and vocal outcome. Laryngoscope, 2006, 116(9): 1657-1661.
49. Freeman RK, Wozniak TC, Fitzgerald EB. Functional and physiologic results of video-assisted thoracoscopic diaphragm plication in adult patients with unilateral diaphragm paralysis. Ann Thorac Surg, 2006, 81(5): 1853-1857.
50. Fang Y, Wu J, Zhang M, et al. Conservative rehabilitation therapy for respiratory dysfunction due to phrenic nerve sacrifice during resection of massive mediastinal tumor: A case series study. Medicine (Baltimore), 2023, 102(36): e35117.
51. Remes-Troche JM, Téllez-Zenteno JF, Esta?ol B, et al. Thymectomy in myasthenia gravis: Response, complications, and associated conditions. Arch Med Res, 2002, 33(6): 545-551.
52. Agatsuma H, Yoshida K, Yoshino I, et al. Video-assisted thoracic surgery thymectomy versus sternotomy thymectomy in patients with thymoma. Ann Thorac Surg, 2017, 104(3): 1047-1053.
53. Huang Y, Su L, Zhang Y, et al. Risk factors for postoperative myasthenic crisis after thymectomy in patients with myasthenia gravis. J Surg Res, 2021, 262: 1-5.
54. Claytor B, Cho SM, Li Y. Myasthenic crisis. Muscle Nerve, 2023, 68(1): 8-19.
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