AB007. Is phrenic nerve sparing worthwhile for phrenic-involved thymic epithelial tumors: a retrospective cohort study
6 affiliations
- 1Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- 2Department of Thoracic Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
- 3Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- 4Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- 5Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
- 6Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
Abstract
Background: To determine whether phrenic nerve (PN) sparing offers a worthwhile trade-off between functional preservation and oncologic safety compared with resection in PN-involved thymic epithelial tumors (TETs), and to establish an objective tool for postoperative respiratory risk stratification.
Methods: In this retrospective cohort of TETs with PN invasion, 122 propensity score–matched cases were analyzed from 2016 to 2024. PN preservation or resection was determined intraoperatively based on the extent of invasion. Diaphragmatic elevation (DE) ratio was calculated as [(preoperative diaphragm–apex distance − postoperative distance)/preoperative distance] × 100% according to X-rays, and cutoff values were defined by respiratory complication risk. Perioperative and oncologic outcomes were compared between PN-preservation and PN-resection groups.
Results: Overall perioperative morbidity and recovery outcomes were comparable between the PN-sparing and PN-resection groups. However, tumor progression was significantly more frequent following PN-sparing (39.3% vs. 23.0%), resulting in worse progression-free survival (P=0.03), although overall survival remained comparable. Multivariable analysis identified PN preservation as an independent predictor of progression (P=0.049). Furthermore, our ROC-derived DE classification (mild ≤15%, moderate 15%–25%, severe ≥25%) predicted severe postoperative respiratory complications (P<0.001).
Conclusions: PN resection improves progression-free survival without increasing severe perioperative complications, though overall survival remains comparable.
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BibTeX
@article{zhu2026ab007,
title = {{AB007. Is phrenic nerve sparing worthwhile for phrenic-involved thymic epithelial tumors: a retrospective cohort study}},
author = {Junkan Zhu and Yongqiang Ao and Zhengyang Lin and Jiahao Jiang and Jian Gao and Yuansheng Zheng and Xifei Jiang and Wei Wu and Junzheng Liu and Rongkui Luo and Jihong Dong and Shuai Wang and Jianyong Ding},
journal = {Mediastinum},
year = {2026},
month = oct,
doi = {10.21037/med-26-ab007},
url = {https://doi.org/10.21037/med-26-ab007},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - AB007. Is phrenic nerve sparing worthwhile for phrenic-involved thymic epithelial tumors: a retrospective cohort study
AU - Junkan Zhu
AU - Yongqiang Ao
AU - Zhengyang Lin
AU - Jiahao Jiang
AU - Jian Gao
AU - Yuansheng Zheng
AU - Xifei Jiang
AU - Wei Wu
AU - Junzheng Liu
AU - Rongkui Luo
AU - Jihong Dong
AU - Shuai Wang
AU - Jianyong Ding
PY - 2026
DA - 2026/10/30
JO - Mediastinum
DO - 10.21037/med-26-ab007
UR - https://doi.org/10.21037/med-26-ab007
AB - Background: To determine whether phrenic nerve (PN) sparing offers a worthwhile trade-off between functional preservation and oncologic safety compared with resection in PN-involved thymic epithelial tumors (TETs), and to establish an objective tool for postoperative respiratory risk stratification. Methods: In this retrospective cohort of TETs with PN invasion, 122 propensity score–matched cases were analyzed from 2016 to 2024. PN preservation or resection was determined intraoperatively based on the extent of invasion. Diaphragmatic elevation (DE) ratio was calculated as [(preoperative diaphragm–apex distance − postoperative distance)/preoperative distance] × 100% according to X-rays, and cutoff values were defined by respiratory complication risk. Perioperative and oncologic outcomes were compared between PN-preservation and PN-resection groups. Results: Overall perioperative morbidity and recovery outcomes were comparable between the PN-sparing and PN-resection groups. However, tumor progression was significantly more frequent following PN-sparing (39.3% vs. 23.0%), resulting in worse progression-free survival (P=0.03), although overall survival remained comparable. Multivariable analysis identified PN preservation as an independent predictor of progression (P=0.049). Furthermore, our ROC-derived DE classification (mild ≤15%, moderate 15%–25%, severe ≥25%) predicted severe postoperative respiratory complications (P<0.001). Conclusions: PN resection improves progression-free survival without increasing severe perioperative complications, though overall survival remains comparable.
SN - 2522-6711
ER -